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Appositional angle closure and conversion of primary angle closure into glaucoma after laser peripheral iridotomy
  1. Li Qiu1,2,
  2. Yujie Yan1,3,
  3. Lingling Wu1
  1. 1 Department of Ophthalmology, Peking University Third Hospital, Beijing, China
  2. 2 Department of Ophthalmology, First Hospital of Baoding, Baoding, China
  3. 3 Department of Ophthalmology, China-Japan Friendship Hospital, Beijing, China
  1. Correspondence to Dr Lingling Wu, Peking University Eye Center, Peking University Third Hospital, Beijing 100105, China; wullc{at}


Purpose To determine the relationship between appositional angle closure (AppAC) and the conversion of primary angle closure (PAC) into primary angle closure glaucoma (PACG) after laser peripheral iridotomy (LPI).

Methods Consecutive patients with PAC were included in this prospective cohort study. The eyes of the included patients who had undergone LPI with five or more reliable visual field (VF) tests in at least 5 years were analysed. Baseline AppAC was diagnosed when the trabecular meshwork and iris were located appositionally on the ultrasound biomicroscopy image. The criteria for PAC conversion were based on development of glaucomatous optic neuropathy and corresponding VF defects. Other factors such as age and vertical cup-to-disc ratio (VCDR) were also investigated by univariate and multivariate logistic regression analyses.

Results 128 patients were assessed at baseline. 80 eyes of 58 patients fulfilled the inclusion criteria. The mean follow-up period was 6.67 ± 1.33 years. PAC conversion was observed in 20 eyes. The frequency of PAC conversion was significantly higher in eyes with AppAC > 2 quadrants at baseline (58.3%, 7/12) than in those with AppAC ≤ 2 quadrants (19.1%, 13/68; p < 0.05). Compared with the non-converting group, the age and VCDR at baseline were both higher in the converting group (p < 0.05). Wider AppAC, older age and higher VCDR were significantly associated with PAC conversion.

Conclusions 25% of PAC eyes of Chinese patients converted into PACG eyes in more than 5 years after LPI. AppAC > 2 quadrants were related to the PAC conversion. Older baseline age and higher VCDR were also associated with PAC conversion.

  • glaucoma
  • anterior chamber
  • public health
  • optic nerve
  • treatment lasers

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  • LQ and YY are joint first authors.

  • Contributors LQ and YY contributed equally to this work and are joint first authors. LW was the corresponding author. 1. Contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data: LQ, YY and LW. 2. Drafting the work or revising it critically for important intellectual content: LQ, YY and LW. 3. Final approval of the version published: LiQ, YY and LW. 4. Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: LQ, YY and LW.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data relevant to the study are included in the article or uploaded as supplementary information.

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