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  • Acute Angle-Closure After Mydriasis in PACS

    By Jean Shaw
    Selected by Henry D. Jampel, MD, MHS
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    Journal Highlights

    Ophthalmology Glaucoma, November/December 2022

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    Friedman et al. evaluated the risk of acute angle-closure (AAC) attacks following pharmacologic dilation in people who were classified as being primary angle-closure suspects (PACS). They found that the risk of incident AAC was extremely low in these indi­viduals during six years of follow-up. They also found that prophylactic laser peripheral iridotomy (LPI) reduced this risk even further.

    For this study, known as the Zhong­shan Angle-Closure Prevention Trial, the researchers enrolled 889 PACS with bilateral disease. Participants’ mean age was 59.3 ± 5 years (range, 50-70 years of age). Patients were treated with LPI in one randomly selected eye; the other eye served as an untreated control. During the 72 subsequent months, participants had their pupils dilated six times with 5% phenylephrine and .5% tropicamide. The main outcome measures were the incidence and risk of postmydriasis AAC in LPI- and untreated eyes.

    In LPI-treated eyes, one bilateral AAC attack occurred after mydriasis at the two-week post-LPI visit. No other occurrences of AAC took place in these eyes. In the control (untreated) eyes, four eyes developed AAC. Two of these four attacks occurred spontaneously, for a risk of .44 AAC events per 1,000 eye-years—and two took place follow­ing dilation (one at 54 months and the other at 72 months of follow-up), for a postmydriasis risk of one AAC attack per 1,587 dilations in untreated eyes.

    Overall, the results indicate that it is generally safe for patients to under­go dilation following iridotomy, the researchers said. They also suggested that it is reasonable to consider LPI for people who require frequent dilation—although they cautioned that a full discussion of risks and benefits of LPI needs to occur with potential candi­dates for the procedure.

    Finally, as this study evaluated Chinese subjects, the results may not be fully generalizable to other racial and ethnic groups, the researchers noted.

    The original article can be found here.