Immediate argon laser peripheral iridoplasty as treatment for acute attack of primary angle closure glaucoma - A preliminary study

Objective: This study aimed to examine the intraocular pressure (IOP)-lowering effects and safety of immediate argon laser peripheral iridoplasty (ALPI) as a first-line treatment for acute primary angle-closure glaucoma (PACG). Design: A prospective cohort study. Participants: Ten consecutive patients with their first attack of PACG, with IOP of 40 mmHg or greater, were recruited into the study. Intervention: On presentation, each patient received topical pilocarpine (4%) and timolol (0.5%) and immediate ALPI as primary treatment. The IOPs at 15, 30, and 60 minutes after ALPI were documented by applanation tonometry, When the corneal edema had settled, laser peripheral iridotomy was performed as a definitive treatment. Main Outcome Measures: The IOP, corneal edema, and complications from ALPI were measured. Results: The mean IOP of this group of patients was reduced from 59.5 +/- 10.4 mmHg to 28.7 +/- 14.9 mmHg at 15 minutes, 21.7 +/- 13.1 mmHg at 30 minutes, and 16.0 +/- 9.4 mmHg at 60 minutes after ALPI. No complications from the laser procedure were encountered during the study period. In nine of the ten patients, the corneal edema cleared up 1 hour after ALPI. In the remaining patient, the cornea cleared up 2 hours after ALPI. Conclusion: From this preliminary study, immediate ALPI, without adjunctive systemic antiglaucoma treatment, appeared to be very effective in controlling the IOP and returning corneal clarity in acute PACG, Its safety also appeared reassuring and did not have the risks associated with conventional systemic therapies.