Incidence of acute angle closure in patients with primary angle closure without prophylactic iridotomy during pharmacological mydriasis for cataract surgery.

Abstract

The objective was to study the incidence of acute primary angle closure (acute PAC) during pharmacologic mydriasis before cataract surgery and changes in anterior chamber angle parameters in patients with primary angle closure diseases (PACD) with and without prophylaxis laser peripheral iridotomy (LPI). This was a prospective, comparative study of cataract patients with PACD with and without prophylaxis LPI presented at the Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand during June 2022 to December 2023. The incidence of acute PAC during pharmacologic mydriasis prior to cataract surgery was recorded. Changes in anterior chamber depth (ACD) and anterior chamber angle parameters measured with anterior segment optical coherence tomography before and after cataract surgery were compared between groups using Student t test. There were 195 eyes of 116 patients with a mean age of 70 years enrolled in the study. Eighty patients were women and 36 were men. There were 99 eyes without prophylaxis LPI and 96 eyes with LPI. There was significantly more angle-closure glaucoma in the non-LPI group than in the LPI group. Preoperatively, all anterior chamber angle parameters were significantly greater in the LPI group than in the non-LPI group (P < .001 all parameters), except ACD (P = .83) and anterior chamber width (ACW) (P = .30). All participants underwent uneventful cataract surgery. Postoperatively, all parameters of the anterior chamber angle and ACD increased significantly in both groups. When comparing between groups, all postoperative anterior chamber angle parameters were not significantly different between the groups, but ACD was significantly greater (P = .036) and ACW was lower in the LPI group (P = .008). There was no incidence of acute PAC occurring during pharmacological mydriasis before cataract surgery in both groups. There was no incidence of acute PAC in patients with and without prophylaxis LPI during pharmacological mydriasis in the preoperative preparation for cataract surgery. Eyes without LPI showed significantly lower preoperative anterior chamber angle parameters compared to eyes with previous LPI, but not significantly different postoperatively. The benefits of prophylactic LPI for PACD scheduled for cataract surgery must be further investigated.