Comparison of Laser Iridotomy and Lensectomy Outcomes for Acute Primary Angle Closure

PURPOSE: To compare the clinical outcomes of the different treatments for acute primary angle closure (APAC). METHODS: We retrospectively reviewed the clinical charts of 87 eyes of 87 patients undergoing treatment for APAC. We investigated the best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), corneal endothelial cell density (ECD), and secondary interventions after each treatment. RESULTS: The pretreated IOP was 56.4 ± 9.0 mmHg. As the first treatment for APAC, all eyes underwent topical 2% pilocarpine and systemic mannitol administration. Subsequent laser iridotomy (LI) and lensectomy were necessary in 29 eyes (33%) and 35 eyes (40%), respectively. Bullous keratopathy developed in 1 eye (1%), and following glaucoma surgery was required in 7 eyes (8%). The BSCVA at the final follow-up was 0.16 ± 0.53 and 0.01 ± 0.20 logMAR (Mann–Whitney U test, p=0.149), the IOP was 12.8 ± 2.6, and 12.6 ± 2.9 mmHg (p=0.860), and the ECD was 2295.9 ± 658.2 and 2244.1 ± 622.0 cells/mm(2) (p=0.735) in the LI and lensectomy groups, respectively. CONCLUSIONS: Approximately 26% of eyes with APAC were resolved after the initial medical treatment, and subsequent surgical treatments, such as LI and lensectomy, were required in 33% and 40% of eyes, respectively. We found no significant differences in the BSCVA, the IOP, or the ECD among LI and lensectomy treatment groups.