Effect of Anticoagulants and Surgeon-Related Factors on Short-term Outcomes of Laser Peripheral Iridotomy

Purpose: To assess the effects of surgeon-related factors on laser peripheral iridotomy (LPI) outcomes by comparing residents and glaucoma specialists, and to look for demographic and clinical predictive factors associated with LPI complications. Design: Retrospective cohort study. Participants: Patients who underwent LPI performed by a resident physician were included as cases, and patients who underwent LPI performed by a glaucoma specialist were included as controls. In patients who underwent multiple sessions of laser therapy, only the information from the first session of each eye was included in the study. Methods: Demographic and clinical information were gathered from the pre-LPI, 1-week, 1-month, and 3-month follow-up visits. The following information was recorded from the LPI session: total laser energy, presence of bleeding, and post-laser intraocular pressure (IOP). Information gathered from the follow-up visits included visual acuity (VA), IOP, hyphema, and need to repeat LPI. A logistic regression analysis with modification for rare events was used to examine the relationship between the dependent variables and the group, adjusted for the clinical and demographic characteristics of patients. Main Outcome Measures: The LPI procedure parameters (total energy), postoperative VA and IOP, risk for complications, and need for re-treatment were compared between groups using odds ratio (OR) measurements. Results: A total of 333 eyes were included in the study. The residents used statistically significant higher total energy compared with the glaucoma specialists' group (P < 0.001). After adjusting for demographic characteristics, antiplatelet/anticoagulant use, and laser energy parameters, we found that the patients of the residents group had a significantly increased likelihood for re-treatment within 3 months (OR, 3.38; 95% confidence interval [CI], 1.31-8.73) and anterior chamber bleeding (OR, 7.48; 95% CI, 1.07-52.02). Conclusions: Although LPI is an effective and minimally invasive procedure, evidence shows that a higher level of experience leads to clinically and statistically significant better outcomes. (C) 2019 by the American Academy of Ophthalmology