eprintid: 10070625 rev_number: 28 eprint_status: archive userid: 608 dir: disk0/10/07/06/25 datestamp: 2019-03-21 08:32:17 lastmod: 2021-09-25 23:22:47 status_changed: 2019-03-21 08:32:17 type: article metadata_visibility: show creators_name: He, M creators_name: Jiang, Y creators_name: Huang, S creators_name: Chang, DS creators_name: Munoz, B creators_name: Aung, T creators_name: Foster, PJ creators_name: Friedman, DS title: Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial ispublished: pub subjects: MOOR divisions: UCL divisions: B02 divisions: C07 divisions: D08 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: BACKGROUND: Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. METHODS: In this randomised controlled trial, bilateral primary angle closure suspects aged 50-70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. FINDINGS: Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30-0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. INTERPRETATION: Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. FUNDING: Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China. date: 2019-04-20 date_type: published official_url: https://doi.org/10.1016/S0140-6736(18)32607-2 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1641102 doi: 10.1016/S0140-6736(18)32607-2 pii: S0140-6736(18)32607-2 lyricists_name: Foster, Paul lyricists_name: Jiang, Yuzhen lyricists_id: PJFOS52 lyricists_id: YJIAN59 actors_name: Novi, Maya actors_id: MNOVI52 actors_role: owner full_text_status: public publication: The Lancet volume: 393 number: 10181 pagerange: 1609-1618 event_location: England issn: 1474-547X citation: He, M; Jiang, Y; Huang, S; Chang, DS; Munoz, B; Aung, T; Foster, PJ; He, M; Jiang, Y; Huang, S; Chang, DS; Munoz, B; Aung, T; Foster, PJ; Friedman, DS; - view fewer <#> (2019) Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial. The Lancet , 393 (10181) pp. 1609-1618. 10.1016/S0140-6736(18)32607-2 <https://doi.org/10.1016/S0140-6736%2818%2932607-2>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10070625/3/He_2019%2003%20March%20%20-%20ZAP%20manuscript%20Lancet%20R2final.pdf