The aim of this study was to evaluate the efficacy and safety of laser peripheral iridoplasty combined with laser pupil plasty in the treatment of acute primary angle-closure glaucoma.

From January 2014 to July 2015, sixty-two patients in Handan Eye Hospital (the Third Hospital of Handan) with acute primary angle-closure glaucoma (68 eyes) who were not treated with intraocular pressure reduction for the first acute attack were collected. Among them, 15 cases (17 eyes) were male and 47 cases (51 eyes) were female with an average age of 67.5±8.5 years. All patients had intraocular pressure≥40 mmHg (1 mmHg=0.133 kPa). The enrolled patients were randomly divided into two groups: laser treatment group and drug group. The laser treatment group was treated with combined laser (laser peripheral iridoplasty combined with laser pupil plasty), and drug group was treated with traditional medication. Intraocular pressure was measured by TA03 Icare tonometer before treatment, 1 h and 2 h after treatment, respectively. Changes of cornea and anterior chamber were recorded between groups. Rescue was successful when intraocular pressure dropped to 30 mmHg or below after 2 h of treatment, and failure to control intraocular pressure below 30 mmHg after 2 h of treatment was failed treatment. Age, intraocular pressure and onset time in the laser and drug groups were described by mean ± standard deviation. Independent sample t-test was used for inter-group comparison. The number of eyes and percentage were used to describe the power of two components, and chi-square test was used to compare. The comparison of intraocular pressure between two groups before treatment, 1 h and 2 h after treatment was performed by two-factor repeated measurement analysis of variance.

After 1 h after treatment, 14 eyes in the laser group were successfully rescued, with a success rate of 41.2%; 15 eyes in the drug group were successfully rescued, with a success rate of 44.2%; 18 eyes in the 2 h after treatment, laser group were successfully rescued, with a success rate of 52.9%; 20 eyes in the drug group were successfully rescued, with a success rate of 58.2%. There was no statistical difference in success rate between two groups after 1 h and 2 h after treatment (χ²=0.06, 0.24; P>0.05). The visual acuity of the laser group was light perception to 0.4 before treatment, hand moving to 0.6 after 1 h after treatment, and hand moving to 0.6 after 2 h after treatment. The visual acuity of the drug group was light perception 0.4 before treatment, light perception to 0.8 after 1 h after treatment, and light perception to 0.8 after 2 h after treatment. The main complications in two groups were inflammation in the anterior chamber and corneal endothelium fold, but there were no serious complications such as intraocular infection and subchoroidal hemorrhage. The mean intraocular pressure in the laser group was (56.9±8.7) mmHg, (37.9±16.2) mmHg and (32.9±16.4) mmHg before treatment, 1 h and 2 h after treatment, respectively. Intraocular pressure decreased after treatment, and the difference was statistically significant (t=6.02, 7.76; P<0.05). The mean intraocular pressure in the drug group was (55.8±9.5) mmHg, (37.6±17.7) mmHg and (30.6±18.2) mmHg before and after treatment for 1 h and 2 h, respectively. Intraocular pressure decreased after treatment, and the difference was statistically significant (t=5.28, 7.16; P<0.05). However, there was no statistical difference in intraocular pressure between two groups at each time point (t=0.89, 0.58, 0.85; P>0.05).

Both combined laser therapy and traditional therapy can rapidly reduce intraocular pressure during acute attack of primary angle-closure glaucoma. Laser therapy is safe and effective, it can avoid the side effects of drug therapy to the body, and it is an important adjuvant therapy in the treatment of acute attack of acute primary angle-closure glaucoma.