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

Research output: Contribution to journalArticle

Abstract

Background: Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. Methods: In this randomised controlled trial, bilateral primary angle closure suspects aged 50–70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. Findings: Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30–0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. Interpretation: Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. Funding: Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.

Original languageEnglish (US)
Pages (from-to)1609-1618
Number of pages10
JournalThe Lancet
Volume393
Issue number10181
DOIs
StatePublished - Apr 20 2019

Fingerprint

Lasers
Randomized Controlled Trials
Angle Closure Glaucoma
China
Incidence
Natural Science Disciplines
Charities
Intention to Treat Analysis
Solar System
Intraocular Pressure
Tertiary Care Centers
Glaucoma
Registries
Safety

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Laser peripheral iridotomy for the prevention of angle closure : a single-centre, randomised controlled trial. / He, Mingguang; Jiang, Yuzhen; Huang, Shengsong; Chang, Dolly S.; Munoz, Beatriz; Aung, Tin; Foster, Paul J.; Friedman, David S.

In: The Lancet, Vol. 393, No. 10181, 20.04.2019, p. 1609-1618.

Research output: Contribution to journalArticle

He, Mingguang ; Jiang, Yuzhen ; Huang, Shengsong ; Chang, Dolly S. ; Munoz, Beatriz ; Aung, Tin ; Foster, Paul J. ; Friedman, David S. / Laser peripheral iridotomy for the prevention of angle closure : a single-centre, randomised controlled trial. In: The Lancet. 2019 ; Vol. 393, No. 10181. pp. 1609-1618.
@article{f040d80c78f34e1c9101c083c30cb92b,
title = "Laser peripheral iridotomy for the prevention of angle closure: a single-centre, randomised controlled trial",
abstract = "Background: Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. Methods: In this randomised controlled trial, bilateral primary angle closure suspects aged 50–70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. Findings: Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95{\%} CI 0·30–0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. Interpretation: Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. Funding: Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.",
author = "Mingguang He and Yuzhen Jiang and Shengsong Huang and Chang, {Dolly S.} and Beatriz Munoz and Tin Aung and Foster, {Paul J.} and Friedman, {David S}",
year = "2019",
month = "4",
day = "20",
doi = "10.1016/S0140-6736(18)32607-2",
language = "English (US)",
volume = "393",
pages = "1609--1618",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier Limited",
number = "10181",

}

TY - JOUR

T1 - Laser peripheral iridotomy for the prevention of angle closure

T2 - a single-centre, randomised controlled trial

AU - He, Mingguang

AU - Jiang, Yuzhen

AU - Huang, Shengsong

AU - Chang, Dolly S.

AU - Munoz, Beatriz

AU - Aung, Tin

AU - Foster, Paul J.

AU - Friedman, David S

PY - 2019/4/20

Y1 - 2019/4/20

N2 - Background: Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. Methods: In this randomised controlled trial, bilateral primary angle closure suspects aged 50–70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. Findings: Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30–0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. Interpretation: Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. Funding: Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.

AB - Background: Primary angle-closure glaucoma affects 20 million people worldwide. People classified as primary angle closure suspects have a higher but poorly quantified risk of developing glaucoma. We aimed to assess efficacy and safety of laser peripheral iridotomy prophylaxis against primary angle-closure glaucoma in Chinese people classified as primary angle closure suspects. Methods: In this randomised controlled trial, bilateral primary angle closure suspects aged 50–70 years were enrolled at the Zhongshan Ophthalmic Center, a tertiary specialised hospital in Guangzhou, China. Eligible patients received laser peripheral iridotomy in one randomly selected eye, with the other remaining untreated. The primary outcome was incident primary angle closure disease as a composite endpoint of elevation of intraocular pressure, peripheral anterior synechiae, or acute angle-closure during 72 months of follow-up in an intention-to-treat analysis between treated eyes and contralateral controls. This trial is registered with the ISRCTN registry, number ISRCTN45213099. Findings: Of 11 991 screened individuals, 889 individuals were randomly assigned from June 19, 2008 (889 treated and 889 untreated eyes). Incidence of the primary outcome was 4·19 per 1000 eye-years in treated eyes compared with 7·97 per 1000 eye-years in untreated eyes (hazard ratio 0·53; 95% CI 0·30–0·92; p=0·024). A primary outcome event occurred in 19 treated eyes and 36 untreated eyes with a statistically significant difference using pair-wise analysis (p=0·0041). No serious adverse events were observed during follow-up. Interpretation: Incidence of angle-closure disease was very low among individuals classified as primary angle closure suspects identified through community-based screening. Laser peripheral iridotomy had a modest, albeit significant, prophylactic effect. In view of the low incidence rate of outcomes that have no immediate threat to vision, the benefit of prophylactic laser peripheral iridotomy is limited; therefore, widespread prophylactic laser peripheral iridotomy for primary angle-closure suspects is not recommended. Funding: Fight for Sight, the Sun Yat-Sen University 5010 Project Fund, Moorfields Eye Charity, and the National Natural Science Foundation of China.

UR - http://www.scopus.com/inward/record.url?scp=85064327097&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85064327097&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(18)32607-2

DO - 10.1016/S0140-6736(18)32607-2

M3 - Article

C2 - 30878226

AN - SCOPUS:85064327097

VL - 393

SP - 1609

EP - 1618

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10181

ER -