Yuan, Yixiong; Wang, Wei; Xiong, Ruilin; Zhang, Jian; Li, Cong; Yang, Shaopeng; Friedman, David S; ... He, Mingguang; + view all Yuan, Yixiong; Wang, Wei; Xiong, Ruilin; Zhang, Jian; Li, Cong; Yang, Shaopeng; Friedman, David S; Foster, Paul J; He, Mingguang; - view fewer (2023) 14-Year Outcome of Angle-Closure Prevention with Laser Iridotomy in the Zhongshan Angle Closure Prevention Study: Extended Follow-Up of a Randomized Controlled Trial. Ophthalmology 10.1016/j.ophtha.2023.03.024. (In press).

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Abstract

Purpose: This study aimed to evaluate the efficacy of laser peripheral iridotomy (LPI) prophylaxis for primary angle closure suspects (PACS) after 14 years and to identify risk factors for the conversion from PACS to primary angle closure (PAC)./ Design: An extended follow-up of Zhongshan Angle Closure Prevention (ZAP) study./ Participants: A total of 889 Chinese patients aged 50 to 70 years with bilateral PACS./ Methods: Each patient received LPI in one randomly selected eye, with the fellow untreated eye serving as a control. Since the risk of glaucoma was low and acute angle closure (AAC) only occurred in rare cases, the follow-up was extended to 14 years despite substantial benefits of LPI reported after the 6-year visit./ Main Outcome Measures: The primary outcome was incidence of PAC, a composite endpoint including peripheral anterior synechiae (PAS), intraocular pressure (IOP) > 24 mmHg, or AAC. Results During the 14 years, 390 LPI-treated eyes and 388 control eyes were lost to the follow-up. A total of 33 LPI-treated eyes and 105 control eyes reached primary endpoints (P <0.01). Within them, twelve eyes developed AAC or primary angle closure glaucoma (AAC: five control eyes and one LPI-treated eye; PACG: four control eyes and two LPI-treated eyes). The hazard ratio for progression to PAC was 0.31 (95% confidence interval, 0.21–0.46) in LPI-treated eyes compared with control eyes. At the 14-year visit, LPI-treated eyes had severer nuclear cataract, higher IOP, larger angle width and limbal anterior chamber depth (LACD) than control eyes. Higher IOP, shallower LACD, and central anterior chamber depth (CACD) were associated with an increased risk of developing endpoints in control eyes. In the treated group, eyes with higher IOP, shallower LACD, or less IOP elevation after dark room–prone provocative tests (DRPPT) were more likely to develop PAC after LPI./ Conclusions: Despite a two-third decrease in PAC incidence after LPI, the cumulative risk of PAC was relatively low in the community-based PACS population over 14 years. Apart from IOP, IOP elevation after DRPPT, CACD, and LACD, more risk factors are needed to achieve precise prediction of PAC occurrence and guide clinical practice.

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