Search

Objective: The Effect of laser peripheral iridotomy in Primary Angle Closure suspect in asymptomatic patients and complications of laser peripheral iridotomy. A single institutional study. This study’s aims to evaluate the effectiveness of Laser peripheral iridotomy(LPI) in eyes with asymptomatic primary angle closure suspect patients. We plan to conduct a retrospective chart review of patients who underwent an LPI , procedure by one glaucoma sub-specialist at Malabar Medical College and Hospital(MMC &H) between January 2017 and December2018. Patients were treated with argon green laser and Nd: Yag laser applications over iris at 7 & 4 clock in one session. Data obtained will include patients’ demographics, sub-type of glaucoma, baseline IOP, Visual Fields, OCT RFNL, number of anti-glaucoma medications, and post- laser IOP at 1 hour. LPI outcomes at 4, 12 and 24weeks post laser will be evaluated by slit lamp examination and four mirror gonioscopy to know the patency of iridotomy. Statistical analyses will be performed comparing patency of iridotomy. Data on presence and degree of transient IOP rise 1-hour post procedure , complication of iridotomy will also be obtained. Design and setting: A retrospective study, A single institutional study. Materials and Methods: In this retrospective study, 67 adult cases of 134 eyes of Primary angle closure suspect(PACS) asypmtomatic patients were underwent 4-mirror zeiss gonioscopy before LPI procedure and slit lamp by Van Hericks ,OCT RFNL,HFA 24-2 Sita Standard ,stereioscopic fundus pictures enrolled into the study from out-patients Department of ophthalmology MMC &H, Calicut for studies between January 2017 and December 2018. Inclusion criteria: All patients who underwent LPI treatment during above mentioned period were included. Exclusion criteria: Eyes with corneal scar, very shallow anterior chamber , neovascular glaucoma , Iridocorneal Endothelial syndrome(ICE) ,previous ALT/ SLT patients, unco-operative patients and Uveitis patients. Main outcome and Measure: To measure the patency of iridotomy at 4, 12 and 24weeks of post LPI treatment, to know the effects on angle of PACS patients. Statistical analyses will be performed comparing baseline gonioscopy with post-laser gonioscopy at4,12 and 24 weeks. Successful outcome will be defined as two or more ITC angles are open after LPI with no need for further medication or laser. Results: A total of 134 eyes in 67 patients participated in this study. All 134 glaucoma eyes were treated with LPI. The 134 eyes with Successful opening of angle more than 2 for at least 24 weeks. Follow-up ranged from 4 to 24 weeks. Gonioscopy was performed in each visit to confirm the angle status and patency of iridotomy.Success is defined as opening ofmore than 2 angles ITC for at least 24 weeks, with no need for further medication or laser treatment. The percentage of open angle at 4 weeks was more 2 angles in 36eyes(26.9%), ITC>3 angles in 28eyes, (20.9%) and ITC>4 angles in 70eyes are (52.2%) ,at 12weeks more 2 angles24eyes (17.9%), ITC> 3angles in ,30 eys(20.9%) ITC>4 angles in 80 eyes(59.7%) and 24 weeks was more 2 angles14 eyes(10.4%), ITC> 3,30eyes (22.4%) ITC>4 angle in90 eyes (67.2%) . The success rate at 24 weeks ITC more than2 angle was 10.4% , ITC>3angles 22.4% and ITC> 4angles in 67.2% respectively.In all cases, IOP was measured within 1 hour and IOP elevation of greater than 8 mm Hg was observed in eyes21 (15.7%) . Mild-to-moderate anterior chamber reaction is seen in 64eyes ,hyphema in 6 eyes, ghost images seen in 2 eyes,2 cases of macular edema, cataract progression seen in 16eyes,and closureof iridotomy in 26eyes were noted. Post laser procedure combination of steroid and antibiotic medication was prescribed for 5 days and IOP pressure more 8 mmHg seen in 21 eyes(15.7%) ,antiglaucoma medications started and oral T. Diamox 250mg 2 tablets wre prescribed followed up after 5 days to reasess the IOP. Conclusions: LPI is an effective treatment option for all patients with in Primary Angle Closure suspect to prevent the acute angle closure glaucoma.LPI is a effective, compliance-free, repeatable,most PACS eyes don’t receive further treatment and safe therapeutic modality having only minor, transient, self-limiting or easily controlled side effects with no sequelae. Progression to PACG is uncommon in PACS and PAC. Despite our methodology, the inherent limitations of studies should be considered, and conclusion drawn from our pooled results should be interpreted with caution. Future large-volume, well-designed with extensive follow-up are awaited to confirm and update the findings of this analysis

Context: Assessing dental anxiety as a predictor of the likely behavior of the child in the dental operatory is of paramount importance for a clinician to render quality care. Aim: This study aims to correlate the dental anxiety of preschool children as shown during the doll placement test with that of their behavioral patterns during the first dental visit. Settings and Design: This cross-sectional study was conducted between the ages of 3–7 years. Materials and Methods: During their first dental visit, the background variables were elicited from parent/guardian at the reception desk. Later at the play area, the child was given a set of dolls representing dentist, child, and mother to place them in a model dental office having a dental chair. The child was then taken for the initial oral examination, during which the behavior of the child was rated using Frankl's Behavior Rating Scale. The data collected were analyzed using Chi-square test and binary regression analysis. Results: The observed association between the doll placement pattern and the behavior of the patient during dental treatment was statistically significant (P < 0.001). The binary regression analysis showed that the child's unpleasant previous medical and parent's unpleasant dental experiences had higher odds favoring uncooperative behavior (46.63 and 41.93, respectively). Conclusions: The child's behavior on the dental chair is associated with the doll placement pattern, which is also influenced by experiences of the child during his/her encounter with the medical doctor and previous dental experiences of their parents.