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Angle Closure and Angle Closure Glaucoma - part 6

Tỷ lệ tăng IOP cấp sau LPI là thấp do để tiền xử lý bình thường của mắt với chủ đề alpha-agonists.15 Những bệnh nhân mà một cành IOP có nhiều khả năng xảy ra, là những người | Laser and Medical Treatment of Primary Angle Closure Glaucoma 41 IOP Elevation The incidence of acute IOP rise following LPI is low due to the routine pretreatment of eyes with topical alpha-agonists.15 The patients in whom an IOP spike is more likely to occur are those with advanced PACG and extensive synechial closure of the angle. The small amount of trabecular meshwork which is not closed by PAS is likely to have compromised outflow function and becomes blocked by the iris pigment and tissue generated by the PI. The result is an acute rise in IOP. A course of oral acetazolamide starting immediately following LPI and continued for two to three days may be considered in patients with advanced PACG undergoing LPI. Sustained rises in IOP can occur following LPI. These patients need to be monitored closely and treated with topical and systemic IOP-lowering medications. The use of topical steroids may be a factor contributing to sustained elevation of IOP post-LPI. Topical non-steroidal anti-inflammatory agents can be used as an alternative to steroids in these patients. Excessive anterior chamber inflammation post-laser may be more common in people with thick dark irides e.g. Asians. Late complications of LPI Posterior synechiae The development of posterior synechiae following LPI can result in a permanently miotic pupil. Possible factors which may contribute to posterior synechiae formation include increased contact between the posterior iris and the anterior lens surface after LPI the use of miotic agents and anterior chamber inflammation. Accelerated cataract formation possible late complication There is concern that LPI may stimulate cataract formation or accelerate progression of existing lens opacities. A recent publication reports progression of pre-existing posterior subcapsular lens opacities in fellow eyes treated with LPI.16 There is no control group to compare the findings with and there may be other factors present underlying PAC topical medication use