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Inicio Archivos de la Sociedad Española de Oftalmología (English Edition) Peripheral yttrium aluminum garnet (YAG) iridotomy versus phacoemulsification in...
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Vol. 89. Issue 9.
Pages 352-360 (September 2014)
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Vol. 89. Issue 9.
Pages 352-360 (September 2014)
Original article
Peripheral yttrium aluminum garnet (YAG) iridotomy versus phacoemulsification in primary angle closure: Prospective comparative study
Iridotomía periférica láser frente a facoemulsificación en el cierre angular primario: estudio comparativo prospectivo
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E. Jarrína,
Corresponding author
elejarrin@hotmail.com

Corresponding author.
, C. Cabarga-Nozalb, A. Almendralb, F.J. Muñoz-Negreteb
a Servicio de Oftalmología, IISFJD, Hospital Rey Juan Carlos, Móstoles, Madrid, Spain
b Servicio de Oftalmología, IRYCIS, Hospital Ramón y Cajal, Madrid, Spain
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Tables (4)
Table 1. Clinical data obtained in the 3 visits for phacoemulsification and YAG laser peripheral iridotomy, comparing baseline and post-surgery values.
Table 2. Statistical significance of the difference observed between the phacoemulsification and peripheral laser iridotomy groups for clinically relevant variables.
Table 3. Analysis per quadrants: score in Shaffer classification and anterior chamber amplitude measured automatically with Pentacam in each visit. Comparison between the two branches of treatment.
Table 4. Anterior chamber measurements obtained automatically with Pentacam camera in the 3 visits for phacoemulsification and laser peripheral iridotomy, and comparison between baseline and post-treatment values.
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Abstract
Purpose

A study was designed to determine and describe the changes induced in the anterior segment of the eye and the intraocular pressure (IOP) after laser peripheral iridotomy (LPI) versus phacoemulsification in primary angle closure suspects (PACS) and primary angle closure (PAC).

Methods

Forty-seven eyes (47 patients) with Shaffer gonioscopy 0-II were included and split into 2 groups: cataract surgery (n=29) or LPI (n=18), depending on the lens sclerosis and visual acuity. Tonometry, gonioscopy, funduscopy, and automated measurements of the anterior chamber by Pentacam were performed before the intervention, and one and 3 months after the technique.

Results

Phacoemulsification reduces IOP after one and 3 months (P<.01). LPI reduces IOP after 3 months (P<.04), and after one month (P<.38). IOP was 16.2mmHg (SD: 3.59) in the phacoemulsification group vs 16.83mmHg (SD: 2.36) in the LPI group after one month (P=.4), and 15.52 (SD: 2.95) vs 16.05 (SD: 2.46) in the third month (P=.5). There were no significant differences in the antiglaucoma drugs.

Shaffer gonioscopy grading was greater in the phacoemulsification group vs in the LPI group one and 3 months after the intervention (P=.01). The highest difference between both techniques was found in the superior quadrant. The anterior chamber depth, angle and volume by Pentacam were wider in the phacoemulsification group after one and 3 months (P<.01).

Conclusions

Although phacoemulsification and LPI could both be effective techniques in the prevention of pupillary block in PAC, faster and greater amplitude of the angle and the anterior chamber can be obtained after phacoemulsification than after LPI.

Keywords:
Primary angle closure
Primary angle closure suspects
Narrow angle
Peripheral YAG iridotomy
Phacoemulsification
Cataract surgery
Anterior chamber depth
Anterior chamber volume
Anterior chamber angle
Resumen
Objetivo

Describir los cambios en el segmento anterior y en la presión intraocular (PIO) entre la iridotomía periférica láser (IPL) y la facoemulsificación en pacientes con sospecha de cierre angular primario (PACS) y cierre angular primario (PAC).

Método

Se seleccionaron 47 ojos de 47 pacientes que presentaban un ángulo 0-II (Shaffer) en la gonioscopia y se excluyó a los pacientes con lesiones glaucomatosas. Según la esclerosis cristaliniana y la agudeza visual se separaron en 2 grupos: IPL (n=18) o facoemulsificación (n=29). Se realizó tonometría, gonioscopia, funduscopia y medidas de la cámara anterior (CA) con Pentacam antes de cada intervención, al mes y a los 3 meses.

Resultados

La facoemulsificación redujo la PIO al mes y a los 3 meses (p<0,01), mientras que la IPL redujo la PIO de forma estadísticamente significativa a los 3 meses (p<0,04; al mes p=0,38). La PIO fue 16,1mmHg (DE: 3,59) en el grupo facoemulsificación versus 16,83mmHg (DE: 2,36) en el grupo IPL al mes (p=0,4) y 15,52 (DE: 2.95) versus 16,05 (DE: 2,46) a los 3 meses (p=0,5). No se encontraron diferencias significativas en la media de fármacos antiglaucomatosos.

La apertura angular mediante gonioscopia fue mayor en el grupo de facoemulsificación (p<0,01), encontrándose la mayor diferencia en el cuadrante superior. La profundidad, el ángulo y el volumen de la CA obtenidos con Pentacam fueron superiores en el grupo de facoemulsificación (p<0,01).

Conclusiones

Tanto la IPL como la facoemulsificación son técnicas efectivas para prevenir el bloqueo pupilar en PAC, pero con la facoemulsificación se obtiene mayor amplitud del ángulo y de la CA de forma precoz.

Palabras clave:
Cierre angular primario
Sospecha de cierre angular primario
Ángulo estrecho
Iridotomía periférica láser
Facoemulsificación
Profundidad de cámara anterior
Volumen de cámara anterior
Ángulo camerular

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