Purpose To compare the effect and safety of laser initiated treatment for primary angle closure glaucoma in a developing setting in China compared to trabeculectomy initiated treatment.
Methods 165 patients with chronic PACG were retrospectively included and follow-up for a minimum of 12 months. 54 patients were performed by laser peripheral iridotomy (group 1(n=23 eyes): PAS<6 clock hours; group 2(n=54 eyes): PAS>=6 clock hours;). 111 patients were performed by trabeculectomy with antimetabolites(group 3, n=111 eyes). IOP, medications and complications were recorded.
Results IOP at each visit (1m, 3m, 6m, 12m, 18m) was significantly lower in group 3 than those in group 1 and group 2. Mean IOP during follow-up in group 3 (13.98±3.10mmHg) was significantly lower than that in group 1 (17.00±3.15mmHg) and group 2 (22.32±7.48mmHg). IOP fluctuation (defined by Max IOP-Min IOP) in group 2 (10.73±9.09mmHg) was larger than that in group3 (6.59±3.83mmHg). 6 eyes in patients by LPI (baseline PAS>=6 clock hours) were performed by trabeculectomy in the final visit. 34.8% eyes (8/23) in group 1 and 42.6% eyes (23/54) in group 2 needed IOP-lowering medications, while 6.3% (7/111) in group 3.
Conclusions Trabeculectomy initiated treatment in chronic PACG appears to be better in lowering IOP and maintain long-term IOP fluctuation. Laser initiated treatment for chronic PACG may not be VERY appropriate in developing countries.