Follow-up of angle closure glaucoma suspects after laser iridotomy in Caucasians with normal intraocular pressure at diagnosis

Objective: To study the long-term outcome of Caucasian eyes with iridotrabecular trabecular apposition or peripheral anterior synechiae (PAS) and fellow eyes with narrow angles only, in eyes with intraocular pressure (IOP) <22 mm Hg at diagnosis and treated with laser peripheral iridotomy (LPI). Design: Cohort study. Participants: Two hundred and fifty-seven Caucasian phakic patients (469 eyes) with a minimum follow-up of 2 years that had both an undilated and dilated gonioscopy after LPI. Methods: In this retrospective cohort study, we included phakic patients with a minimum follow-up of 2 years that had both an undilated and dilated gonioscopy after LPI. Excluded were patients with pseudoexfoliation, intraocular surgery, prior acute angle-closure glaucoma or antiglaucoma medication, suspicious glaucoma disk, secondary angle closure, or iridoplasty. We censored patients after any kind of intraocular surgery. Main outcome measures where the date of IOP elevation and beginning of antiglaucoma medication. Results: Four hundred and sixty-nine eyes were included. Mean follow-up was 8.5 +/- 5.53 years. No apposition/PAS was observed in 84.0% of the eyes after LPI. At 10 years, 38.7% of the eyes had increased IOP and 17.3% required medication. No difference in outcomes was observed between argon and neodymium-YAG LPI or between the eyes with and without apposition/PAS before LPI. Younger patients and those with no apposition/PAS after LPI had a better prognosis (p < 0.01). Conclusions: Many angle closure glaucoma suspects developed increased IOP and required medical treatment after LPI.