Argon laser peripheral iridoplasty in the management of phacomorphic glaucoma

BACKGROUND AND OBJECTIVE: To document the efficacy and safety of argon laser peripheral iridoplasty (ALPI) as a temporizing measure in the treatment of phacomorphic glaucoma and to evaluate the mid-term visual outcomes. PATIENTS AND METHODS: The cords of all patients with phacomorphic treated with ALPI from December 1999 to December 2002 were retrospectively reviewed. The primary outcome measure was the rate of successful control of intraocular pressure. Successful cases with at least 12 months of follow-up were further analyzed regarding their outcomes after cataract surgery, including visual acuity, intraocular pressure (IOP), and angle status. RESULTS: ALPI was performed as an initial step in the management of phacomorphic glaucoma In 21 eyes of 21 patients. IOP was successfully controlled in 17 eyes (80.75%), with a statistically significant decrease at 2 and 24 hours postoperatively (P <.0001). Elective cataract surgery was performed in 16 of the 17 successful cases and 12 of these patients completed at least 12 months of follow-up. After a mean follow-up period of 25.58 months, IOP was normal without medications in 11 eyes and only 1 patient required antiglaucoma eye drops to control IOP. All patients achieved a visual acuity of at least 1/60 and 8 (66.67%) of them achieved a visual acuity of 6/21 or better. All patients maintained an open angle without further surgical intervention. No complication was noted directly attributable to ALPI. m CONCLUSION: ALPI is a safe and efficacious measure for the initial management of phacomorphic glaucoma, simultaneously obviating the need to operate in highly inflamed eyes in an emergency setting and achieving satisfactory mid-term visual outcome.