Glau Hour 1-22-2024 Powerpoint Presentation

Glau Hour 1-22-2024 Powerpoint Presentation

1. PREPARED BY: Dr. Lovely Keziah c. flores & dr. Ahnna Patrizia dp . Agustin DEPARTMENT OF OPHTHALMOLOGY Ilocos Training and Regional Medical Center Parian, San Fernando City, La Union 2500 Laser peripheral iridotomy for the prevention of angle closure: a single- centre , randomised controlled trial Mingguang He, Yuzhen Jiang, Shengsong Huang, Dolly S Chang, Beatriz Munoz, Tin Aung, Paul J Foster*, David S Friedman* JANUARY 22, 2024

2. outline Introduction Methodology Results and Discussion Summary

3. Introduction Glaucoma Most common neurodegenerative disease (80M) Second most common cause of blindness PACG: 25% Angle closure causes: location of lens, iris thickness and insertion, ciliary body location, degree of pupillary block Laser peripheral iridotomy: first line treatment for PAC and PACG since mid 1970s Efficacy and safety for prophylactic laser peripheral iridotomy unclear Objective of study: assess efficacy of LPI in preventing PAC or AAC development in Chinese people with PACS

4. METHODOLOGY Study design and participants Zhongshan Angle Closure Prevention (ZAP) Trial Single- centre , randomized interventional controlled trial 50-70 years old from urban district in Guangzhou Bilateral PACS Requirements: No PAS, 21 mm Hg or less < 0.7 CDR CDR asymmetry </= 0.2 NRR greater than 0.1 vertical DD Normal or borderline glaucoma hemifield test results

5. METHODOLOGY Exclusion criteria Severe health problems resulting in <1 year life expectancy Previous intraocular surgery or penetrating eye injury Media opacity preventing LPI BCVA worse than 20/40 IOP increase > 15 mm Hg after dilation or after a 15-min dark room prone provocation testing

6. METHODOLOGY Randomization and masking Pregenerated list of random numbers was used to perform randomization data monitoring centre at Wilmer Eye Institute (Baltimore, MD, USA)

7. METHODOLOGY Procedures LPI done by a trained doctor using Abraham lens YAG laser machine ( Visulas YAG III, Carl Zeiss Meditec , Dublin, CA, USA) was used to create an iridotomy starting with an initial setting of 1∙5 mJ Dexamethasone ED Q1 for first 24 hours then QID daily x 1 week after LPI

8. METHODOLOGY Outcomes Follow up visits of treated and untreated eyes after 2 weeks, 6 months, 18 months, 36 months, 54 months, and 72 months Primary outcome was the incidence of primary angle closure by eyes by 72 months, defined as the composite of three study endpoints: (1) intraocular pressure measurements above 24 mm Hg on two separate occasions. (2) development of at least one clock hour of peripheral anterior synechiae in any quadrant; (3) an episode of acute angle closure.

9. METHODOLOGY Outcomes Secondary outcomes: presenting visual acuity intraocular pressure, total angle width on gonioscopy limbal anterior chamber depth any adverse events during laser peripheral iridotomy or at any follow-up visits

10. METHODOLOGY Statistical Analysis Primary outcomes at 36 months on the basis of previous reports stating a 3-year incidence of endpoints near 20% Sample size estimation: pair-wise statistics, such as McNemar’s test All analyses were based on intention-to-treat principle Participants who prematurely received laser peripheral iridotomy in the control eye but did not withdraw from the study were followed and analysed according to randomisation (n=24)

11. RESULTS

12. RESULTS

13. RESULTS

14. DISCUSSION The rate of developing any angle closure endpoint was much lower than expected in primary angle closure suspects’ eyes, less than 1% per year (+) LPI: 47% reduction in the risk of developing PAC or an acute attack Among 129 primary angle closure suspects (94% white), 19∙4% developed a study endpoint during a mean 2∙7-year follow-up in a clinical setting.19 However, in a community cohort of 485 Chinese individuals with primary angle closure suspects, only 4∙1% progressed to primary angle-closure glaucoma over 6 years of follow-up with a progressive reduction of anterior chamber depth occurring in 28% of patients community-based study in Mongolia reported that 1∙6% of primary angle closure suspects aged 50 years and older (with or without prophylactic laser peripheral iridotomy) eventually developed primary angle-closure glaucoma in 6 years.1

15. DISCUSSION Risk of developing PAC over 6 years is low incidence rate of progression was marginally higher for eyes with four quadrants of angle closure at baseline (5∙40% over 6 year community-based samp

16. DISCUSSION Strengths of the study: LPI done in only one eye Low drop out , masked allocation, objective assessment of various parameters, long-term follow ups, testing in an ethnic group with high risk of PACG

17. DISCUSSION Limitations Not able to mask participants and outcome examiners No AS OCT (PAS may have been missed) Gonioscopy partially subjective Chinese individuals of 50 years of age and older with PACS

18. SUMMARY Incident disease occurred very rarely Prophylactic LPI very significant We estimate 44 people need to be treated to prevent one case of early disease over the subsequent 6 years, with no effect on visual function