RANDOMIZED TRIAL OF PHACOEMULSIFICATION WITH AND WITHOUT PERIPHERAL IRIDOTOMY TO PREVENT INTRAOPERATIVE COMPLICATIONS IN CATARACT SURGERY WITH OCCLUDABLE ANGLES

Mousumi Malakar, Julie Pegu, Binita Verma

Abstract


Introduction: Cataract surgery in patients with Primary angle closure or very narrow angles poses a unique set of challenges and risks. Laser
peripheral iridotomy (LPI) relieves the pupillary block and is most effective intervention for the majority of cases of PAC.
Objectives: We conducted a prospective randomized controlled trial to compare the role of prophylactic LPI in cataract surgery with occludable
angles.
Materials and methods: Total of 60 eyes of 60 patients were recruited with 30 eyes each in group. In group A, prophylactic LPI was done before
the surgery, in Group B surgery was done without LPI. The outcome was intraocular miosis during the surgery including other intraoperative safety
parameters like iris prolapse, difficulty in capsulorrhexis, increased AC fluctuation, rise in posterior vitreous pressure and PCR. The surgeons were
given a questionnaire at the end of surgery to make a note of the above mentioned parameters. Intraoperative miosis was present in 13.3% patients
in group A and 20% in group B. Surgeon comfortability was not there in 13 cases, out of which 9 (30%) were without LPI and 4 (13.33%) were with
LPI.
Conclusions: This is the first prospective study to evaluate the role of YAG PI in preventing intraoperative complications in cataract patients with
occludable angles, a preoperative LPI has potential to decrease intraoperative complications. The present study was conducted with experienced
surgeons. So, a further study can be planned with different levels of surgeon experience to find out if a true benefit exists with prophylactic LPI.


Keywords


Anterior chamber(AC), Laser peripheral iridectomy(LPI), Primary angle closure(PAC)

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