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Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects: A Review

Filippopoulos, Theodoros; Danias, John; Karmiris, Efthymios; Megevand, Gordana Sunaric; Rhee, Douglas J; Gazzard, Gus; Topouzis, Fotis; (2023) Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects: A Review. Ophthalmology Glaucoma 10.1016/j.ogla.2023.06.004. (In press).

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Abstract

PURPOSE: To examine the generalizability, discuss limitations, and critically appraise recommendations on the management of Primary Angle Closure Suspects (PACS) that emerged as a result of recent randomized clinical trials challenging the widely accepted clinical practice of offering laser peripheral iridotomy (LPI) to PACS patients. To synthetize findings from these and other studies. DESIGN: Narrative Review. SUBJECTS: Patients classified as PACS. METHODS: The the Zhongshan Angle-Closure Prevention (ZAP)-Trial and the Singapore Asymptomatic Narrow Angle Study (ANA-LIS) along with accompanying publications were reviewed. Epidemiologic studies reporting on the prevalence of primary angle closure glaucoma and other precursor forms of the disease were also analyzed along with publications reporting on the natural course of the disease or studies reporting on outcomes after prophylactic LPI. MAIN OUTCOME MEASURES: Incidence of progression to more severe forms of angle closure. RESULTS: Patients recruited in recent randomized clinical trials are asymptomatic, do not have cataracts and may be younger and have on average deeper anterior chambers depth compared to patients treated with LPI in clinic. CONCLUSIONS: The ZAP-Trial and ANA-LIS clearly represent the best available data on PACS management, additional parameters however may need to be considered when physicians face patients in clinic. PACS patients encountered at tertiary referral centers may represent more advanced cases with respect to ocular biometric parameters and may be at higher risk for disease progression compared to those recruited through population-based screening.

Type: Article
Title: Rethinking Prophylactic Laser Peripheral Iridotomy in Primary Angle-Closure Suspects: A Review
Location: United States
DOI: 10.1016/j.ogla.2023.06.004
Publisher version: https://doi.org/10.1016/j.ogla.2023.06.004
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Institute of Ophthalmology
URI: https://discovery.ucl.ac.uk/id/eprint/10173577
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