Servillo, Andrea; Tun, Tin A; Yoo, Chungkwon; Kumar, Rajesh S; Baskaran, Mani; Nongpiur, Monisha E; Friedman, David S; ... Aung, Tin; + view all Servillo, Andrea; Tun, Tin A; Yoo, Chungkwon; Kumar, Rajesh S; Baskaran, Mani; Nongpiur, Monisha E; Friedman, David S; Foster, Paul J; Xu, Benjamin; Aung, Tin; - view fewer (2025) Long-Term Persistent Angle Closure and Anatomical Changes After Laser Iridotomy in Primary Angle Closure Suspects. Ophthalmology 10.1016/j.ophtha.2025.10.027. (In press).

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Abstract

Purpose: To evaluate the proportion of subjects with, and anatomical predictors of, persistent angle-closure five years after laser peripheral iridotomy (LPI) in primary angle-closure suspects (PACS), and to assess anterior segment anatomical changes over the 5-year follow-up. // Design: Subanalysis of randomized controlled trial (the Singapore Asymptomatic-Narrow-Angles-Laser-Iridotomy Study). // Participants: Of the 480 subjects, 375 phakic subjects completed the 5-year follow-up; 130 had complete imaging (baseline UBM and annual AS-OCT). // Methods: All subjects underwent comprehensive ophthalmologic examination, with one randomly selected eye receiving LPI. In all subjects with 5-year follow-up, the proportion of eyes with persistent gonioscopic angle closure (≥2 quadrants) was calculated. In eyes with complete imaging, predictors of persistent angle-closure and longitudinal changes of biometric parameters were calculated. // Main Outcome Measures: Odds ratio (OR) (95% confidence interval, CI) for baseline predictors; estimates (95% CI) for longitudinal changes. // Results: Among 375 participants with 5-year follow-up, persistent gonioscopic angle closure occurred in 124 LPI-treated eyes (33.1%). LPI significantly reduced the risk of persistent gonioscopic angle closure at 5 years (OR=0.12 [0.09–0.17]; p<0.001). In the imaging cohort (n=130), 34 eyes (26.2%) had persistent gonioscopic angle closure, a proportion not significantly different from that of the entire cohort (p=0.17). In multivariable analysis, greater iris thickness at 750 μm at baseline (IT750, OR=1.71 [1.21–2.57] per 0.1 mm; p=0.004) and younger age at baseline (OR=0.30 [0.13–0.61] per 10 years; p=0.002) were associated with persistent angle closure, while lower mean gonioscopic grade was borderline significant (OR=0.35 [0.12–1.00] per grade; p=0.050). Additional analysis showed that greater IT750 was significantly associated with persistent angle-closure only in eyes with baseline AOD750 below the median (p=0.005). Angle width and anterior chamber area (p<0.001 for all) significantly increased within two years post-LPI and remained stable thereafter. Iris curvature and pupillary diameter significantly decreased during the first year (p<0.001 for both) remaining stable thereafter. No significant longitudinal changes were observed in untreated fellow eyes. // Conclusions: LPI induces sustained angle widening in approximately two-thirds of subjects, with stable long-term anatomical benefit. A thicker iris at baseline in eyes with a narrower angle was predictive of persistent angle-closure despite treatment.

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