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SIGNIFICANCE Intraocular pressure and ocular biometric changes were similar before and after laser iridotomy in response to the water-drinking test in a cohort of patients at risk of angle closure. The water-drinking test does not seem to be a good provocative test to determine which eyes would benefit from a laser iridotomy. Our data call into question the preoperative predictive value of this test. PURPOSE The aim of this study was to evaluate the effect of water-drinking test on intraocular pressure and ocular biometric parameters, before and after laser peripheral iridotomy, in patients with an occludable angle. METHODS Twenty-seven patients, who met the inclusion criteria and had at least 180 degrees of iridotrabecular apposition, underwent a complete eye examination followed by the measurement of ocular biometric (using LenStar LS-900; Haag-Streit AG, Koeniz, Switzerland) and anterior chamber parameters (using Pentacam HR; Oculus Optikgerate GmbH, Wetzlar, Germany). All the measurements were repeated 30 minutes after the water-drinking test. Two weeks after laser peripheral iridotomy, all the measurements were repeated both before and after the water-drinking test. RESULTS The mean ± SD of the age of the participants was 57 ± 9 years, and 23 (85.2%) were male. Intraocular pressure increased after the water-drinking test in both pre-laser peripheral iridotomy (17.0 vs. 19.3 mmHg, P < .001) and post-laser peripheral iridotomy (15.6 vs. 18.6 mmHg, P < .001) conditions. The thickness values of central cornea increased slightly after the water-drinking test in pre-laser peripheral iridotomy (535 vs. 538 μm, P = .001) compared with post-laser peripheral iridotomy (532 vs. 536 μm, P = .003). The water-drinking test had no significant effect on other biometric or anterior chamber parameters, before or after laser peripheral iridotomy. CONCLUSIONS The water-drinking test increased intraocular pressure, both before and after laser peripheral iridotomy. Laser peripheral iridotomy had no significant effect on the amount of intraocular pressure change after the water-drinking test. The water-drinking test has no effect on other biometric or anterior chamber parameters.

Supplemental Digital Content is Available in the Text., Purpose: To describe a simple technique that uses posterior chandelier illumination during Descemet membrane endothelial keratoplasty in cases of severe bullous keratopathy (BK). Methods: Five eyes of 4 patients with advanced BK undergoing Descemet membrane endothelial keratoplasty were retrospectively analyzed. The pupil of the host eye was not treated with mydriatic or miotic agents. The chandelier illuminator was inserted transconjunctivally into the vitreous cavity from the pars plana. Results: In all eyes, BK was secondary to laser iridotomy, which was performed for prevention or treatment of angle closure glaucoma. The implanted graft was clearly confirmed in the anterior chamber using activated chandelier illumination. The graft was immediately attached to the host cornea, with eventual healing of BK in all eyes. No complication involving insertion or removal of the 25-gauge trocar and the chandelier illuminator was observed. No vision-threatening complication was observed in any of the 5 eyes. Conclusions: The chandelier illuminator provided good visibility of the anterior chamber and enhanced the safety of surgery by preventing formation of an inverted graft.

Cataract surgery has been demonstrated to lower intraocular pressure (IOP) in eyes with glaucoma. The evidence is strong in angle-closure patients that cataract surgery improves IOP and dramatically reduces the future risk for IOP spikes and acute attacks. Randomized controlled trials (RCTs) have shown that cataract surgery may be preferable to laser iridotomy or phacotrabeculectomy. The data are so convincing that an RCT has been undertaken to assess whether clear lens extraction may be appropriate following acute attacks and in cases of uncontrolled IOP. The case favoring cataract surgery in open-angle glaucoma (OAG) is more controversial. Impressive IOP reduction has been shown in OAG patients when the patients are stratified by preoperative IOP. The patients with the highest preoperative IOPs have pressure reductions up to 8.5 mm Hg. However, these findings have been criticized for methodological weaknesses. Combining cataract surgery with microinvasive glaucoma surgery in phaco-plus procedures provides further options for lens-based glaucoma surgery. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

To evaluate the effect of laser peripheral iridotomy (LPI) on biometric parameters including central anterior chamber depth (CACD) in primary angle closure suspect eyes.Eyes classified as primary angle closure suspect were enrolled in this interventional case series. Biometry with Lenstar (Haag-Streit AG, Koeniz, Switzerland) was performed before LPI and 6 weeks afterward. Central anterior chamber depth, lens thickness, axial length, and central corneal thickness were measured before and after the intervention.Forty eyes of 40 patients with mean age of 56.5 ± 5.5 years were studied. Mean central anterior chamber depth was 2.07 ± 0.21 mm before and 2.08 ± 0.19 mm after LPI (p = 0.8). There was no significant change in lens thickness, axial length, and central corneal thickness after LPI.Central anterior chamber depth "measured by Lenstar" does not change after LPI in primary angle closure suspect eyes.

Graft insertion into the anterior chamber is one of the most important procedures for successful Descemet membrane endothelial keratoplasty (DMEK). Especially in eyes with fragile zonular fibers and a shallow anterior chamber, smooth graft insertion tends to become more difficult. Ophthalmic viscoelastic devices (OVDs) can usually help to retain the space in the anterior chamber and to improve the safety of manipulations during various ophthalmic surgeries. Therefore, we postulated that graft insertion into the anterior chamber could be improved by their use. The purpose of this study is to investigate the availability and efficacy of OVDs during graft insertion in DMEK surgery. A total of 11 eyes of 9 patients with bullous keratopathy who underwent DMEK were retrospectively analyzed. The cause of bullous keratopathy was corneal endothelial decompensation following laser iridotomy in all eyes. We used low viscous dispersive OVD (Opegan) to maintain the anterior chamber depth during graft insertion in all of the eyes. The graft insertion was uneventful in all of the eyes. The inserted graft was attached to the back surface of the cornea. However, 2 eyes needed rebubbling, and after rebubbling, all of the 2 grafts completely attached to the back surface of the cornea. The best spectacle-corrected visual acuity significantly improved 6 months after surgery (P

PURPOSE To report plateau iris configuration (PIC) in subjects who have the long anterior zonule (LAZ) clinical trait. METHODS Two elderly African American males who exhibited LAZ and had partial appositional angle closure persisting after laser iridotomy were imaged with high-resolution ultrasonography to examine for PIC. A third elderly LAZ subject who had narrow angles without closure was also imaged for PIC. Each subject was tested for a serine 163 arginine mutation (S163R) C1q tumor necrosis factor-related protein 5 gene (C1QTNF5/CTRP5) mutation, which may be associated with the LAZ phenotype. RESULTS All 3 LAZ subjects also had PIC, an unlikely association due to chance alone. None carried the S163R CTRP5 mutation. CONCLUSIONS LAZ and PIC may have association and require study because LAZ might be a useful indicator for an increased likelihood of PIC and risk of angle closure. Mutation other than CTRP5 S163R should also be considered for the LAZ trait, which could be an important phenotypic marker in genetic studies.

PURPOSE To determine if laser iridotomy altered the anterior segment anatomy of patients with plateau iris configuration. METHODS Twenty eyes of 9 female and 1 male patients were imaged using an ultrasound biomicroscope within 19 weeks before and 52 weeks after laser iridotomy. Measurements obtained included the anterior chamber depth (ACD), trabecular-ciliary process distance (TCPD), iris thickness (IT), angle opening distance at 500 micrometers (AOD), iridozonular distance (IZD), and trabecular-iris angle (TIA). Comparisons of the pre- and post- iridotomy measurements were made using a two-tailed paired t test. RESULTS Laser iridotomy elicited no statistically significant change in ACD, TCPD, IT, AOD, or TIA. However, IZD was decreased (P < 0.05) in both eyes after laser iridotomy. Configuration of the irides was flat before and after laser iridotomies. CONCLUSION This study suggests that laser iridotomy did not alter anterior segment anatomy, probably because of the fixed anterior insertion of the iris and ciliary body in plateau iris configuration. The decrease in IZD distance may be the result of a small posterior movement of the iris due to a reduction in relative pupillary block, secondary to laser iridotomy. The small reduction in relative papillary block in plateau iris configuration does not alter the width of the anterior chamber angle as measured by AOD and TIA.

A survey of glaucoma laser parameters and practices was mailed to all United States members of the American Society of Cataract and Refractive Surgery (ASCRS) in March 1999. Approximately 19% (947) of the 5100 surveys were returned. The survey assessed parameters used for laser trabeculoplasty, laser iridotomy, and gonioplasty. Respondents also answered questions about the application of these laser therapies in a wide variety of clinical situations. The results were cross-tabulated by age, number of laser trabeculoplasties performed per month, fellowship training in glaucoma, and geographic location.

SummaryTopical treatment with 1% apraclonidine significantly reduced, but did not eliminate, the occurrence of postoperative increases in intraocular pressure (IOP) I h after either argon laser trabeculoplasty or laser iridotomy. IOP before laser trabeculoplasty in the 121 nontreated patients (24.2

A 33-year-old man of East African heritage was referred for glaucoma evaluation. His ocular history includes a laser iridotomy in both eyes. The corrected distance visual acuity is hand movements in the right eye and 20/125 in the left eye. On maximum medical therapy, the intraocular pressure (IOP) is 36 mm Hg and 21mmHg, respectively. The central corneal thickness is 514 mm in both eyes. There is an afferent pupillary defect in the right eye. The anterior chamber is extremely shallow in each eye, despite a patent laser peripheral iridotomy (LPI). No angle structures were visible on gonioscopic examination. Pressure gonioscopy did not improve

Anterior chamber angles were measured before and after laser iridotomy in 12 patients with narrow angles using Scheimpflug video image analysis. The angle increased from a mean of 15.3 +/- 2.5 degrees (mean +/- SD) to 21.2 +/- 3.3 degrees following iridotomy. This difference was significant (p < 0.0005). There was no significant change in the depth of the axial anterior chamber. This instrument may be useful as an adjunct to clinical examination, particularly when an objective, quantitative grading of anterior chamber angle changes is required.