RT Journal Article
SR Electronic
T1 Cataract progression after Nd:YAG laser iridotomy in primary angle-closure suspect eyes
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP bjophthalmol-2021-320929
DO 10.1136/bjophthalmol-2021-320929
A1 Dolly Shuo-Teh Chang
A1 Yuzhen Jiang
A1 Julia Anne Kim
A1 Shengsong Huang
A1 Beatriz Munoz
A1 Tin Aung
A1 Mingguang He
A1 Paul J Foster
A1 David Friedman
YR 2022
UL http://bjo.bmj.com/content/early/2022/05/02/bjophthalmol-2021-320929.abstract
AB Background/Aims Prophylactic laser peripheral iridotomy (LPI) is performed in primary angle-closure suspect (PACS) eyes to prevent acute angle-closure attacks. However, accelerated cataractogenesis is a potential risk of the procedure that may result in decreased visual acuity. We aimed to assess the long-term impact of LPI on cataract formation in Chinese PACS.Methods In the Zhongshan Angle Closure Prevention Trial, eligible bilateral PACS participants received LPI in one randomly selected eye, while the fellow eye remained untreated. Cataract was graded using the Lens Opacity Classification System III, and progression was defined as an increase in grade by at least two units in any category or cataract surgery.Results In total, 889 participants were randomly assigned to LPI in one eye only (mean age 59±5 years, 83% female). At 72 months, treated eyes had slightly higher average nuclear grades (p<0.001). However, there were no differences between eyes for predefined cataract progression (cumulative probability at 72 months: 21.2% in LPI vs 19.4% in control, p=0.401) or cataract surgery (1% for both). While LPI-treated eyes had a 10% higher risk of progression over 6 years (HR=1.10 (95% CI 0.88 to 1.36)), this was not statistically significant. Visual acuity at 72 months was similar in treated and untreated eyes (p=0.43).Conclusion Although lenses were graded on average as slightly more opaque in laser-treated eyes, prophylactic neodymium:yttrium-aluminum-garnet LPI did not cause significant cataract progression. Our results suggest that LPI treatment of asymptomatic narrow angles does not increase the risk of developing clinically meaningful cataract worsening over time.Trial registration number ISRCTN45213099.Data are available on reasonable request. The datasets generated and/or analysed during the current study are available from PJF (p.foster@ucl.ac.uk), DF (david_friedman@meei.harvard.edu) and MH (mingguang_he@yahoo.com) on reasonable request.