JOCGP

10.5005/jp-journals-10008-1152
Anterior Segment Optical Coherence Tomography Changes to the Anterior Chamber Angle in the Short-term
ORIGINAL RESEARCH

Anterior Segment Optical Coherence Tomography

Changes to the Anterior Chamber Angle in the
Short-term following Laser Peripheral Iridoplasty
1
James Chiung Yoong Leong, 2Jeremy O’Connor, 3Ghee Soon Ang, 4Anthony P Wells

ABSTRACT Source of support: This research received funding from the

Capital Vision Research Trust, Wellington, New Zealand.
Purpose: To evaluate, by anterior segment optical coherence
tomography (AS-OCT), the changes in the anterior chamber Conflict of interest: None
angle during the short-term postoperative period after diode
laser peripheral iridoplasty (LPI). INTRODUCTION
Methods: Retrospective, observational study of consecutive
Glaucoma is the leading cause of irreversible blindness
primary angle closure suspect, primary angle closure, or primary
angle closure glaucoma patients who underwent LPI. These worldwide.1 Angle closure glaucoma is the main cause
patients had persistent iridotrabecular contact despite the of visual morbidity from glaucoma in Asian populations,
presence of a patent peripheral iridotomy. thought to blind 10 times more people than primary open
The AS-OCT images of the temporal and nasal anterior angle glaucoma.2 However, angle closure glaucoma is
chamber angles in dark conditions before and after LPI were
also a significant, and likely underdiagnosed, condition in
ana­lyzed. The main outcome measures were changed in AS-
OCT parameters such as trabecular-iris angle (TIA), angle Caucasians.3
opening distance (AOD), trabecular-iris space area (TISA), In the setting of primary angle closure (PAC), the recom-
trabecular-iris contact length (TICL), iris thickness (IT), and maxi- mended initial nonsurgical means of widening the anterior
mum iris bow height (MIBH). Secondary outcome para­meters
chamber drainage angle is by laser peripheral iridotomy
included intraocular pressure (IOP) and postlaser complications.
(LPI), which eliminates pupil block.4 However, a propor-
Results: Images of 14 eyes of 14 patients were assessed. The
mean time from LPI to the follow-up AS-OCT scan was 6 ± 3
tion of eyes will still have residual angle closure, despite
weeks. The IT did not alter significantly after LPI, but there were a successfully performed and patent PI.5 In such patients,
significant increases in the TIA, AOD and TISA, as well as a LPI may be a useful treatment to ameliorate appo­sitional
significant decrease in TICL and MIBH. There were no significant angle closure that may be occurring through nonpupil block
postlaser complications. There was a small decrease in mean
IOP from 17.1 ± 4.0 mm Hg to 14.8 ± 4.6 mm Hg (p = 0.014).
mecha­nisms.6-8 It is thought to achieve this by applying a
thermal energy which contracts the peripheral iris away from
Conclusion: Based on AS-OCT imaging, LPI resulted in signi­
ficant angle widening and iris profile flattening during the short- the trabecular meshwork while, also causing thinning of the
term postoperative period in eyes with persistent angle closure anterior iris in the treatment spots, thereby helping to further
despite the presence of a patent peripheral iridotomy. open the anterior chamber angle. While the strength of current
Keywords: Optical coherence tomography, Angle closure evidence with regard to overall efficacy of LPI remains weak,9
glaucoma, Laser peripheral iridoplasty. at present the consensus among glaucoma experts is that it
How to cite this article: Leong JCY, O’Connor J, Ang GS, Wells remains a useful adjunctive treatment tool for angle closure.10
AP. Anterior Segment Optical Coherence Tomography Changes
Anterior segment optical coherence tomography (AS-OCT)
to the Anterior Chamber Angle in the Short-term following Laser
Peripheral Iridoplasty. J Current Glau Prac 2014;8(1):1-6. is a noncontact imaging modality that rapidly obtains high
resolution cross section images of the anterior segment with
1
the patient seated upright. These features are advan­tageous
Registrar, 2Glaucoma Fellow, 3,4Consultant Ophthalmologist
1
in comparison to older imaging modalities used for assessing
Department of Ophthalmology, Capital and Coast District Health
Board, New Zealand
angle closure, such as ultrasound biomicroscopy (UBM).11
2,3
Previous work by this group utilized AS-OCT to outline
Department of Ophthalmology, Royal Victoria Eye and Ear
Institute, Australia changes in anatomical features of the anterior chamber angle
4
Department of Ophthalmology, Capital Eye Specialists, New
after laser PI in a cohort of patients with angle closure.12,13
Zealand Changes in angle configuration following PI have been
Corresponding Author: James Chiung Yoong Leong, Registrar previously well-described using AS-OCT in various other
Department of Ophthalmology, Capital and Coast District Health clinical populations.14-16
Board, New Zealand, Phone: 6421325533, e-mail: dr.james. LPI has been shown by gonioscopy to result in widening
[email protected]
of the anterior chamber angle in patients with residual angle

Journal of Current Glaucoma Practice, January-April 2014;8(1):1-6 1

James Chiung Yoong Leong et al

closure despite a patent laser PI.17 However, there has been made by the glaucoma specialist (APW) based on the AS-
no direct, quantitative documentation of this angle widening OCT images of all four quadrants, using the same criteria as
effect with AS-OCT, apart from a few isolated case reports.18 deciding whether or not to perform a PI. Essentially, those
With this in mind, the aim of this study was to describe the eyes that had residual iridotrabecular contact in 2 or more
quantitative changes to the anterior chamber angle after quadrants in dark conditions post-PI were deemed to still
LPI in a cohort of patients with residual appositional angle have occludable angles and were selected for LPI.
closure after PI. Exclusion criteria were secondary angle closure (such as
angle neovascularization, trauma and intumescent cataract),
MATERIALS AND METHODS previous intraocular surgery or poor-quality AS-OCT images
that were unsuitable for angle evaluation. As with the original
This was a retrospective case series of patients who under­ cohort, only the right eye was used for analysis if both eyes
went diode LPI at Capital Eye Specialists, Wellington, New were eligible.
Zealand over a 21-month period. This cohort of patients was LPI was performed using the Oculight SLx diode laser.
derived from a previously described cohort of 71 eyes of 71 After pupil constriction with pilocarpine 2%, 30 to 35 shots
patients who had undergone laser PI for primary angle closure were applied on to the iris as peripherally as possible over
suspect (PACS) status, PAC and primary angle closure suspect 360°, using a power between 200 and 350 mW, a 2.5 seconds
(PACG).13 Of this original cohort of 71 eyes, 14 (19.7%) maximum treatment time and a 500 µm spot size. The power
underwent subsequent LPI for persistent irido­trabecular and duration (controlled via footpedal) were titrated to be
contact despite a patent PI, forming the cohort for this study. just enough to cause iris contraction but not superficial iris
Materials and methods used for the initial cohort charring (Fig. 1). Typically, a contact lens was not used but
are outlined in a previous paper.12 Briefly, in the initial occasionally a three-mirror lens was used (avoiding the use
cohort, a full ocular examination was performed for each of a magnifying lens which would decrease the spot size on
newly referred patient with suspected angle closure. This the iris and therefore, affect the power exponentially). After
included best-corrected Snellen acuity, slit-lamp evaluation, LPI, patients were given a 5 day course of topical predni­
Goldmann applanation tonometry, corneal pachymetry, solone acetate 1.0% to relieve postlaser inflammation.
undilated fundoscopy, gonioscopy, and time domain AS-OCT At the follow-up visit, AS-OCT imaging was repeated for
imaging. The AS-OCT was performed by ophthalmic imaging each patient, as well as routine clinical examination, which
technicians with the slit-lamp OCT (Heidelberg Engineering, included IOP measurement, gonioscopy and confirmation
GmBH, Dossenheim, Germany) in both uniform light and that the PI has remained patent after LPI. The AS-OCT
dark (all room lights switched off) conditions, with scans images before and after LPI were reviewed and analyzed
being centered on the pupil. The clinical decision as to for each patient. Although multiple scans of all four anterior
whether the PI was indicated in these patients was made by chamber angle quadrants were captured and treatment
the glaucoma specialist (APW) according to AS-OCT and decisions based on images from all four quadrants, only the
gonioscopic findings. The gonioscopic threshold for PI was horizontal images were analyzed in this study because these
nonvisibility of the trabecular meshwork in at least 180° of provided a clearer view of all the anterior chamber angle
the anterior chamber angle, consistent with the Association structures, in particular the scleral spur and peripheral iris
of International Glaucoma Societies consensus on angle recess, compared to the vertical images.
closure gonioscopic criteria.10 The AS-OCT threshold was The nasal and temporal quadrants for all eyes were
extrapolated from these criteria as being the presence of measured by a single observer a glaucoma fellow (GSA)
iridotrabecular contact, visualized as apposition of peripheral
iris to the inner corneoscleral wall anterior to the scleral spur,
in at least two of four quadrants in dark conditions. These
patients were considered to PACS cases. PAC occurred if
the PACS status was associated with peripheral anterior
synechiae and/or intraocular pressure (IOP) of >21 mm Hg.
PACG was diagnosed if there were concurrent optic disk and
visual field changes characteristic of glaucoma.
All patients had a repeat AS-OCT scan performed a mean Fig. 1: A typical example of a patient treated with unilateral diode
laser peripheral iridoplasty. There is mild anisocoria and visible,
of 6 (± standard deviation 3) weeks after treatment with PI. subtle laser spots in the peripheral iris (left), compared with the
The decision on whether LPI was clinically indicated, was fellow untreated eye (right)

2
 JOCGP

Anterior Segment Optical Coherence Tomography Changes to the Anterior Chamber Angle in the Short-term

who was masked to the identity and sequence of the images iris surface and the inner corneoscleral wall.20 IT 500 was
being evaluated. The observer selected the best quality the perpendicular distance from the anterior iris surface at
image with clearly identifiable anatomical landmarks from 500 mm from the scleral spur to the posterior iris pigment
a series of images of the nasal and temporal quadrants, all epithelial surface.21 The MIBH was used as a surrogate
centered on the pupil, obtained by the ophthalmic imaging marker for iris curvature and was the perpendicular distance
technicians. After the locations of the scleral spur and iris measured from the posterior iris pigment epithelial surface
recess apex were selected, various anterior chamber drainage at its apex (i.e. the point where iris bowing was greatest) to
angle para­meters were calculated utilizing the inbuilt analysis the line joining the iris pigment epithelium at the pupil edge
software. These parameters were: trabecular-iris angle (TIA), to its insertion at the ciliary body.22 The hyper reflective
angle opening distance (AOD), trabecular-iris space area curve on the posterior iris surface marked the iris pigment
(TISA) and anterior chamber depth. In addition, parameters epithelium; its insertion at the ciliary body was the point
not included in the inbuilt analyses were measured manually: where the hyperreflective curve terminated within the ciliary
trabecular-iris contact length (TICL), iris thickness (IT) and body. The secondary outcome measures were IOP and post-
maximum iris bow height (MIBH). The observer GSA had LPI complications.
previously demonstrated moderate to good intraobserver Data were analyzed using Excel software (Microsoft,
reproducibility with the intraclass correlation coefficient USA). Basic descriptive statistics was conducted for patient
statistic on all of these AS-OCT parameters in a larger cohort demographics. Comparison of means was performed with
of patients, from which this present cohort was derived from, the paired t-test for parametric data, while comparison of
using the same AS-OCT instrument and analysis software.13 medians was performed with the Wilcoxon signed rank
Although the AS-OCT images were captured in both light test for nonparametric data. A p value less than 0.05 was
and dark conditions, only results of scans in the dark were considered to be statistically significant. The study was
used for analysis. conducted according to the tenets of the Declaration of
Figures 2A and B show the parameters measured with Helsinki and had received approval from the Central
the AS-OCT. The TIA 500 was the angle between the point Regional Ethics Committee of New Zealand.
of the trabecular meshwork 500 mm from the scleral spur
and the point on the anterior iris perpendicularly, with the RESULTS
apex at the iris recess.19 The TIA 750 was similar to TIA All 14 eyes that underwent LPI out of the original PI cohort
500, except that the angle was measured from the point of of 71 eyes met inclusion criteria and did not fulfil any
the trabecular meshwork 750 mm from the scleral spur. AOD exclusion criteria and were, therefore, included in this study.
500 and AOD 750 were the perpendicular distances from Mean age at treatment was 55.9 (±10.9) years. A total of
the trabecular meshwork at 500 and 750 mm, respectively, 11 patients (79%) were women. Four (29%) had PACG,
anterior to the scleral spur to the anterior iris surface.19 The while the remainder had PAC or PACS. The mean time from
TISA 500 was the trapezoidal area bordered anteriorly by LPI to the follow-up scan was 6.3 ± 2.9 weeks. None of the
the AOD 500, posteriorly by a line from the scleral spur patients had experienced postlaser complications such as
perpendicular to the plane of the inner sclera to the anterior persistent pain and/or photophobia, persistent uveitis, or
iris, superiorly by the inner corneoscleral wall and inferiorly elevated IOP spikes.
by the anterior iris surface.20 TISA 750 was similar to TISA When comparing indicators of angle width (TIA 500,
500, except that it was bordered anteriorly by the AOD 750. TIA 750, AOD 500, AOD 750 and TISA 500) before and
The TICL was the length of contact between the anterior after LPI, there was generally a statistically significant
increase in magnitude. The TICL and MIBH showed a
statistically significant decrease for both nasal and temporal
angles. Iris thickness measurements (IT 500) did not show
any meaningful difference post-LPI. These parameters are
summarized in Table 1 and an example of the AS-OCT
changes after LPI is shown in Figures 3A and B.
The median number of quadrants with persisting
iridotrabecular contact on AS-OCT decreased after LPI from
Figs 2A and B: A schematic diagram of anterior segment optical 4 to 1 (p < 0.001, Z = –3.236; Wilcoxon signed rank test).
coherence tomography measurement parameters. (A) Trabecular- There was also a small but statistically significant drop in
iris angle (TIA) 500, angle opening distance (AOD) 500 and
trabecular-iris space area (TISA) 500. (B) Trabecular-iris contact IOP from 17.1 to 14.8 mm Hg (p = 0.014). The change in
length the parameters is summarized in Table 2.
Journal of Current Glaucoma Practice, January-April 2014;8(1):1-6 3
James Chiung Yoong Leong et al

Figs 3A and B: Representative example of a comparison of AS-OCT in a patient pre (A) and post (B) LPI.
Note the widening of the anterior chamber drainage angle (circled)

Table 1: Changes in anterior chamber and angle parameters post LPI. Various parameters are measured by AS-OCT
in dark conditions for both temporal and nasal angles, and mean ± standard deviation for 14 eyes are compared pre
and post LPI differences
Temporal angle Nasal angle
Preiridoplasty Postiridoplasty Significance Preiridoplasty Postiridoplasty Significance
(t-test) (t-test)
TIA 500 (°) 6.07 ± 6.08 13 ± 6.35 0.002 4.077 ± 5.53 13.214 ± 5.82 <0.001
AOD 500 (mm) 0.055 ± 0.055 0.142 ± 0.073 <0.001 0.033 ± 0.047 0.144 ± 0.057 <0.001
TISA 500 (mm2) 0.038 ± 0.032 0.058 ± 0.034 0.063 0.011 ± 0.016 0.061 ± 0.036 <0.001
TIA 750 (°) 6.79 ± 4.92 14 ± 6.74 <0.001 6.21 ± 5.85 14.21 ± 5.49 <0.001
AOD 750 (mm) 0.092 ± 0.068 0.213 ± 0.119 <0.001 0.079 ± 0.081 0.212 ± 0.081 <0.001
TISA 750 (mm2) 0.092 ± 0.068 0.105 ± 0.054 0.408 0.038 ± 0.038 0.110 ± 0.057 <0.001
TICL (mm) 0.334 ± 0.292 0.082 ± 0.175 0.002 0.586 ± 0.29 0.176 ± 0.174 <0.001
IT 500 (mm) 0.442 ± 0.183 0.421 ± 0.067 0.510 0.432 ± 0.053 0.410 ± 0.103 0.423
MIBH (mm) 0.158 ± 0.090 0.085 ± 0.113 0.017 0.158 ± 0.092 0.063 ± 0.079 <0.001

Table 2: Changes in intraocular pressure, anterior chamber depth and number

of quadrants with persisting iridotrabecular contact on AS-OCT before and
after laser peripheral iridoplasty
Preiridoplasty Postiridoplasty Significance
Mean intraocular 17.11 ± 4.01 14.78 ± 4.55 0.014
pressure (IOP) (paired t-test)
Anterior chamber 2.12 ± 0.43 2.18 ± 0.34 0.34
depth (ACD) (paired t-test)
Median number of 4 1 <0.001
quadrants closed (Wilcoxon
signed rank
test)

DISCUSSION fi­cance for the temporal angle. It is possible that this

difference did not reach statistical significance because of
This study represents to the best of our knowledge, the
our small study sample size. TICL was significantly reduced
only study to demonstrate with AS-OCT, the quantitative
changes in the anterior chamber angle following LPI. Our and IT was not affected. The failure to detect a difference
results demonstrate that in the short-term, in this cohort in iris thickness following LPI may be due to images and
of patients with residual iridotrabecular contact after PI, measurements being taken at cross sections which did not
additional LPI brings about significant widening of the include LPI spots, where maximal iris stromal thinning
anterior chamber angle as measured by AS-OCT. This was would be expected to occur. LPI also appeared to bring
demonstrated by the significant increase in TIA and AOD about a flattening of the iris contour, with a significant
for the temporal and nasal angles, measured at both 500 and decrease in MIBH. This change to peripheral iris contour
750 µm from the scleral spur. Interestingly, although the provides confirmation of the theoretical mechanism of LPI
TISA 500 and 750 increased for both nasal and temporal in causing contraction of the peripheral iris away from the
angles, the change observed did not reach statistical signi­ trabecular meshwork.

4
 JOCGP

Anterior Segment Optical Coherence Tomography Changes to the Anterior Chamber Angle in the Short-term

It is well-established that PI brings about significant was a small but statistically significant decrease in IOP after
changes in various parameters of the anterior chamber angle LPI. This difference in IOP outcome may be due to a more
and numerous studies have previously demonstrated this severe spectrum of angle closure in the above trial population
using AS-OCT as the imaging modality.13,15,16 However, with participants required to have fulfilled criteria for PAC or
changes in the anterior chamber angle after LPI have not PACG. Our study included patients with PACS and was not
been investigated using AS-OCT. Lee et al are the only group specifically designed to assess IOP outcomes following LPI.
to assess imaging characteristics of the anterior chamber in This study has a number of limitations, including the
a similar clinical scenario using Scheimpflug imaging but retrospective study design and relatively small number of
not with AS-OCT.23 The authors compared two groups: patients. It was not possible to determine whether the exact,
one that had PI alone and a second that received LPI in same cross section of the anterior chamber angle was imaged
combination with PI. The authors used a surrogate measure of before and after LPI, although it was endeavored to center
midperipheral anterior chamber depth to assess the angle and the AS-OCT images on the pupil in the central horizontal
found a greater increase in angle widening in those having meridian for all images to achieve maximum consistency.
combined LPI and PI compared to those having PI alone. Bias could have been introduced during measurements of
AS-OCT has emerged as a useful tool in the assessment the angle parameters as the measuring observer (GSA) was
of the anterior chamber angle and indeed has been shown to not masked as to whether the images were pre- or post-LPI,
have a higher degree of sensitivity in the detection of angle but this is mitigated by his being masked to the identity and
closure when compared to gonioscopy.24 It has numerous sequence of the images being evaluated.
advantages over other means of quantitatively assessing the In addition, the image resolution of the time domain AS-
angle, namely UBM and Scheimpflug photography. While OCT platform used in this study may not have been sufficient to
Scheimpflug photography measures certain anterior segment identify the individual iridoplasty spots. It is plausible that if the
characteristics well, it does not image the drainage angle scan cross section was through one of these spots, there may be
fully due to the inability of the camera light to penetrate the local discrepancies in angle configuration in these areas which
corneoscleral limbus. UBM has one major advantage over may not be present globally throughout the entire circumference
AS-OCT in that it is superior in assessing features of the of the drainage angle. However, the theoretical mechanism of
ciliary body, which may have particular importance in this LPI is for some degree of circumferential contraction of the
cohort of patients, in whom angle closure remains despite peripheral iris to occur due to 360° spot application. Therefore,
resolution of pupil block. AS-OCT, however, has a number a follow-up AS-OCT image may not have to be centered directly
of advantages. It is less operator-dependent and hence across a LPI spot for a difference in angle configuration to be
easier to use, has a higher degree of spatial resolution, and detected. This study only utilized scans from the nasal and
is a noncontact test. Its noncontact nature is beneficial for temporal quadrants due to the relative difficulty identifying
both the patient and clinician; it is more comfortable and anatomical landmarks consistently in superior and inferior
potentially safer for the patient, while from the clinician’s quadrants; a methodological issue that has previously been
perspective, there is less likelihood of external pressure addressed in a similar fashion by other groups.15,29,30 The
affecting anterior segment anatomy. AS-OCT has been spectral domain OCT platforms which have been introduced
shown to have good reproducibility and repeatability, as more recently may allow for quicker image acquisition,
well as low interobserver variability,25-27 and has been higher resolution, and image averaging as well as more
demons­trated to be similar to UBM when measuring drainage accurate referencing of the location of each cross sectional
angle parameters quantitatively.20 Our observer, GSA, had scan. A further limitation of AS-OCT is its inability to directly
previously demonstrated moderate to good intraobserver evaluate the ciliary body, such as for rotation, which would
with the AS-OCT instrument and measurement parameters have been of particular interest in this cohort of patients.
used in this study.13 This study does not report gonioscopic findings in the study
The role of LPI for the treatment of angle closure in the cohort as the aim is to quantify changes in angle configuration
nonacute setting is unclear, but there remains a consensus that using AS-OCT.
it is a useful adjunct in the setting of persistent occlu­dable
CONCLUSION
angles after PI.10 Despite this consensus, to date the evi­
dence of its overall efficacy in the clinical setting is lacking.9 This study describes systematically for the first time the
Only one randomized controlled trial has been published changes observed by AS-OCT in the anterior chamber
comparing PI alone to PI in combination with LPI, and this angle configuration induced by LPI in a cohort of patients
study showed no superiority to use of LPI as an adjunct to with residual angle closure after PI. Our data confirm an
PI for IOP control, number of medications or requirement additional anterior chamber angle widening effect and a
for surgery.28 This was in contrast to our results where there small IOP lowering effect with LPI, at least in the short

Journal of Current Glaucoma Practice, January-April 2014;8(1):1-6 5

James Chiung Yoong Leong et al

term. Long-term follow-up of this cohort will be useful 17. Ritch R, Tham CC, Lam DS. Long-term success of argon
to longitudinally assess the longevity of the structural and laser peripheral iridoplasty in the management of plateau iris
syndrome. Ophthalmology 2004;111(1):104-108.
IOP changes, following LPI and its relevance in terms of
18. Leung CK, Chan WM, Ko CY, Chui SI, Woo J, Tsang MK, Tse
glaucoma progression. RK. Visualization of anterior chamber angle dynamics using
optical coherence tomography. Ophthalmology 2005;112(6):
REFERENCES 980-984.
19. Pavlin CJ, Harasiewicz K, Foster FS. Ultrasound biomicroscopy
1. Quigley HA, Broman AT. The number of people with glaucoma of anterior segment structures in normal and glaucomatous eyes.
worldwide in 2010 and 2020. Br J Ophthalmol 2006;90(3):262-267. Am J Ophthalmol 1992;113(4):381-389.
2. Foster PJ, Johnson GJ. Glaucoma in China: how big is the 20. Radhakrishnan S, Goldsmith J, Huang D, Westphal V, Dueker
problem? Br J Ophthalmol 2001;85(11):1277-1282. DK, Rollins AM, Izatt JA, Smith SD. Comparison of optical
3. Ng WS, Ang GS, Azuara-Blanco A. Primary angle closure glau­ coherence tomography and ultrasound biomicroscopy for
coma: a descriptive study in Scottish Caucasians. Clin Experi­ detection of narrow anterior chamber angles. Arch Ophthalmol
ment Ophthalmol 2008;36(9):847-851. 2005;123(8):1053-1059.
4. Thomas R, Walland MJ. Management algorithms for primary 21. He M, Friedman DS, Ge J, Huang W, Jin C, Cai X, Khaw PT,
angle closure glaucoma. Clin Experiment Ophthalmol 2013; Foster PJ. Laser peripheral iridotomy in eyes with narrow
41(3):282-292. drainage angles: ultrasound biomicroscopy outcomes. The Liwan
5. He M, Friedman DS, Ge J, Huang W, Jin C, Lee PS, Khaw PT, Eye Study. Ophthalmology 2007;114(8):1513-1519.
Foster PJ. Laser peripheral iridotomy in primary angle-closure 22. Woo EK, Pavlin CJ, Slomovic A, Taback N, Buys YM.
suspects: biometric and gonioscopic outcomes: the Liwan Eye Ultrasound biomicroscopic quantitative analysis of light-dark
Study. Ophthalmology 2007;114(3):494-500. changes associated with pupillary block. Am J Ophthalmol
6. Ritch R, Liebmann JM. Argon Laser peripheral iridoplasty: a 1999;127(1):43-47.
review. Ophthalmic Surg Lasers 1996;27(4):289-300. 23. Lee JR, Choi JY, Kim YD, Choi J. Laser peripheral iridotomy
7. Ritch R, Tham CCY, Lam DSC. Long term success of argon with iridoplasty in primary angle closure suspect: anterior
laser peripheral iridoplasty in the management of plateau iris chamber analysis by pentacam. Korean J Ophthalmol 2011;
syndrome. Ophthalmology 2004;111(1):104-108. 25(4):252-256.
8. Ritch R, Tham CC, Lam DS. Argon laser peripheral iridoplasty 24. Nolan WP, See JL, Chew PT, Friedman DS, Smith SD,
(ALPI): an update. Surv Ophthalmol 2007;52(3):279-288. Radhakrishnan S, Zheng C, Foster PJ, Aung T. Detection of
9. Ng WS, Ang GS, Azuara-Blanco A. Laser peripheral irido­ primary angle closure using anterior segment optical coherence
plasty for angle-closure. Cochrane Database Syst Rev tomography in Asian eyes. Ophthalmology 2007;114(1):33-39.
2008;16(3):CD006746. 25. Li H, Leung CK, Cheung CY, Wong L, Pang CP, Weinreb RN,
10. Weinreb RN, Friedman DS. Angle closure and angle closure Lam DS. Repeatability and reproducibility of anterior chamber
glaucoma. The Hague, The Netherlands: Kugler publications angle measurement with anterior segment optical coherence
2006. tomography. Br J Ophthalmol 2007;91(11):1490-1492.
11. Weinreb RN, Leung CKS. Anterior chamber angle imaging with 26. Muller M, Dahmen G, Porksen E, Geerling G, Laqua H, Ziegler
A, Hoerauf H. Anterior chamber angle measurement with
optical coherence tomography. Eye 2011;25(3):261-267.
optical coherence tomography: intraobserver and interobserver
12. Ang GS, Wells AP. Factors influencing laser peripheral iridotomy
variability. J Cataract Refract Surg 2006;32(11):1803-1808.
outcomes in white eyes: an anterior segment optical coherence
27. Radhakrishnan S, See J, Smith SD, Nolan WP, Ce Z, Friedman
tomography study. J Glaucoma 2011;20(9):577-583.
DS, Huang D, LiY, Aung T, Chew PT. Reproducibility of
13. Ang GS, Wells AP. Changes in Caucasian eyes after laser
anterior chamber angle measurements obtained with anterior
peripheral iridotomy: an anterior segment optical coherence
segment optical coherence tomography. Invest Ophthalmol Vis
tomography study. Clin Experiment Ophthalmol 2010;38(8):
Sci 2007;48(8):3683-3688.
778-785.
28. Sun X, Liang YB, Wang NL, Fan SJ, Sun LP, Li SZ, Liu WR.
14. Memarzadeh F, Li Y, Chopra V, Varma R, Francis BA, Huang Laser peripheral iridotomy with and without iridoplasty for
D. Anterior segment optical coherence tomography for imaging primary angle-closure glaucoma: 1-year results of a randomized
the anterior chamber after laser peripheral iridotomy. Am J pilot study. Am J Ophthalmol 2010;150(1):68-73.
Ophthalmol 2007;143(5):877-879. 29. Day AC, Garway-Heath DF, Broadway DC, Jiang Y, Hayat
15. How AC, Baskaran M, Kumar RS, He M, Foster PJ, Lavanya R, S, Dalzell N, Khaw KT, Foster PJ. Spectral domain optical
Wong HT, Chew PT, Friedman DS, Aung T. Changes in anterior coherence tomography imaging of the aqueous outflow structures
segment morphology after laser peripheral iridotomy: an anterior in normal participants of the EPIC-Norfolk Eye Study. Br J
segment optical coherence tomography study. Ophthalmology Ophthalmol 2013;97(2):189-195.
2012;119(7):1383-1387. 30. Nongpiur ME, Haaland BA, Friedman DS, Perera SA, He M,
16. Lee KS, Sung KR, Shon K, Sun JH, Lee JR. Longitudinal Foo LL, Bhaskaran M, Sakata LM, Wong TY, Aung T. Classi­
changes in anterior segment parameters after laser peripheral fication algorithms based on anterior segment optical coherence
iridotomy assessed by anterior segment optical coherence tomo­ tomography measurements for detection of angle closure.
graphy. Invest Ophthalmol Vis Sci 2013;54(5):3166-3170. Ophthalmology 2013;120(1):48-54.