Prediction of angle closure after laser peripheral iridotomy: The fourteen-year Zhongshan Angle Closure Prevention trial

Yixiong Yuan; Shaopeng Yang; Wei Wang; Benjamin Y. Xu; Cong Li; Ruilin Xiong; Chimei Liao; Jian Zhang; Qiuxia Yin; Yingfeng Zheng; David S. Friedman; Paul J. Foster; Mingguang He

doi:10.59717/j.xinn-med.2023.100033

The Innovation Medicine > 2023 Vol. 1 > No. 3 > 100033

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Prediction of angle closure after laser peripheral iridotomy: The fourteen-year Zhongshan Angle Closure Prevention trial

1.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
2.
Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangzhou 510060, China
3.
Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou 510060, China
4.
Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Haikou 570311, China
5.
Roski Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA
6.
Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Harvard Medical School, Boston, MA 02114, USA
7.
NIHR Biomedical Research Centre at Moorfields Eye Hospital and UCL Institute of Ophthalmology, London, EC1V 2PD, UK
8.
Experimental Ophthalmology, The Hong Kong Polytechnic University, Hong Kong 999077, China
9.
These authors contributed equally

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Corresponding author: wangwei@gzzoc.com
Received Date: July 20, 2023

Accepted Date: November 06, 2023

Published Online: November 15, 2023

The Innovation Medicine 1(3), https://doi.org/10.59717/j.xinn-med.2023.100033 | Cite this article

GRAPHICAL ABSTRACT

GRAPHICAL ABSTRACT

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PUBLIC SUMMARY

PUBLIC SUMMARY
1. Anterior chamber angle can continue to narrow after laser peripheral iridotomy.
  
  Long-term risk of progression after laser peripheral iridotomy can be predicted.
  
  The narrowing of anterior chamber angle is an important risk factor.
  
  Dynamic changes of intraocular pressure and lens vault are additional predictors.

ABSTRACT

ABSTRACT

Anterior chamber angles in primary angle closure suspects (PACS) can continue to narrow after laser peripheral iridotomy (LPI). The aim of this study is to identify risk factors and develop prediction models for the progression in LPI-treated eyes during a 14-year follow-up. From 2008 to 2010, 889 Chinese participants aged 50-70 years with bilateral PACS were enrolled in the Zhongshan Angle Closure Prevention (ZAP) trial and received LPI in one randomly selected eye. Examinations before LPI included Goldmann tonometry, ultrasound A-scan biometry, both light-room and dark-room anterior-segment optical coherence tomography (AS-OCT). Logistic regression models were built to predict the 14-year risk of progression in PACS eyes after LPI (peripheral anterior synechiae, intraocular pressure [IOP] > 24 mmHg, or acute angle closure). Within 370 eligible PACS eyes, 26 progressed to PAC during 14 years after LPI. For both light-room and dark-room AS-OCT metrics before LPI, the narrowing of anterior chamber angle was identified as risk factor for the 14-year risk of progression in LPI-treated PACS eyes. In addition, change in IOP after dark-room prone provocative test and change in lens vault from light to dark before LPI were found to be negatively associated with the risk of progression during 14 years after LPI. Based on aforementioned predictors, multivariable logistic models provided good performance in the prediction for long-term risk of progression after LPI (area under the curve = 0.80-0.84). This study suggested that closer monitoring is still required for PACS eyes at high risk of progression even after prophylactic LPI.

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REFERENCES

[1]	Prum, B.E., Herndon, L.W., Moroi, S.E., et al. (2016). Primary angle closure preferred practice pattern guidelines. Ophthalmology 123: P1−P40. DOI: 10.1016/j.ophtha.2015.12.023. View in Article CrossRef Google Scholar
[2]	Tham, Y.C., Li, X., Wong, T.Y., et al. (2014). Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology 121: 2081−2090. DOI: 10.1016/j.ophtha.2014.05.013. View in Article CrossRef Google Scholar Scopus
[3]	Quigley, H.A., and Broman, A.T. (2006). The number of people with glaucoma worldwide in 2010 and 2020. Br. J. Ophthalmol. 90: 262−267. DOI: 10.1136/bjo.2005.081224. View in Article CrossRef Google Scholar Scopus
[4]	Radhakrishnan, S., Chen, P.P., Junk, A.K., et al. (2018). Laser peripheral iridotomy in primary angle closure: A report by the American Academy of Ophthalmology. Ophthalmology 125: 1110−1120. DOI: 10.1016/j.ophtha.2018.01.015. View in Article CrossRef Google Scholar
[5]	He, M., Jiang, Y., Huang, S., et al. (2019). Laser peripheral iridotomy for the prevention of angle closure: A single-centre, randomised controlled trial. Lancet 393: 1609−1618. DOI: 10.1016/S0140-6736(18)32607-2. View in Article CrossRef Google Scholar
[6]	Baskaran, M., Kumar, R.S., Friedman, D.S., et al. (2022). The Singapore Asymptomatic Narrow Angles Laser Iridotomy Study: Five-year results of a randomized controlled trial. Ophthalmology 129: 147−158. DOI: 10.1016/j.ophtha.2021.08.017. View in Article CrossRef Google Scholar
[7]	Jiang, Y., Chang, D.S., Zhu, H., et al. (2014). Longitudinal changes of angle configuration in primary angle-closure suspects: The Zhongshan Angle-Closure Prevention Trial. Ophthalmology 121: 1699−1705. DOI: 10.1016/j.ophtha.2014.03.039. View in Article CrossRef Google Scholar
[8]	Yan, W., and He, M. (2017). Predictive medicine in ophthalmology. Ophthalmology 124: 420−421. DOI: 10.1016/j.ophtha.2016.12.018. View in Article CrossRef Google Scholar
[9]	Bao, Y.K., Xu, B.Y., Friedman, D.S., et al. (2023). Biometric risk factors for angle closure progression after laser peripheral iridotomy. JAMA Ophthalmol. 141: 516−524. DOI: 10.1001/jamaophthalmol.2023.0937. View in Article CrossRef Google Scholar
[10]	Jiang, Y., Friedman, D.S., He, M., et al. (2010). Design and methodology of a randomized controlled trial of laser iridotomy for the prevention of angle closure in southern China: The Zhongshan Angle Closure Prevention Trial. Ophthalmic. Epidemiol. 17: 321−332. DOI: 10.3109/09286586.2010.508353. View in Article CrossRef Google Scholar
[11]	Yuan, Y., Wang, W., Xiong, R., et al. (2023). Fourteen-year outcome of angle-closure prevention with laser iridotomy in the Zhongshan Angle-Closure Prevention Study: extended follow-up of a randomized controlled trial. Ophthalmology 130: 786−794. DOI: 10.1016/j.ophtha.2023.03.024. View in Article CrossRef Google Scholar
[12]	Console, J.W., Sakata, L.M., Aung, T., et al. (2008). Quantitative analysis of anterior segment optical coherence tomography images: The Zhongshan Angle Assessment Program. Br. J. Ophthalmol. 92: 1612−1616. DOI: 10.1136/bjo.2007.129932. View in Article CrossRef Google Scholar
[13]	Kattan, M.W., Eastham, J.A., Stapleton, A.M., et al. (1998). A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer. J. Natl. Cancer Inst. 90: 766−771. DOI: 10.1093/jnci/90.10.766. View in Article CrossRef Google Scholar Scopus
[14]	Vickers, A.J., and Elkin, E.B. (2006). Decision curve analysis: A novel method for evaluating prediction models. Med. Decis. Making 26: 565−574. DOI: 10.1177/0272989X06295361. View in Article CrossRef Google Scholar Scopus
[15]	Hong, C., Park, K.H., Hyung, S.M., et al. (1996). Evaluation of pupillary block component in angle-closure glaucoma. Jpn. J. Ophthalmol. 40: 239−243. View in Article Google Scholar Scopus
[16]	Sihota, R., Rishi, K., Srinivasan, G., et al. (2016). Functional evaluation of an iridotomy in primary angle closure eyes. Graefes. Arch. Clin. Exp. Ophthalmol. 254: 1141−1149. DOI: 10.1007/s00417-016-3298-x. View in Article CrossRef Google Scholar Scopus
[17]	Kumar, R.S., Baskaran, M., Chew, P.T., et al. (2008). Prevalence of plateau iris in primary angle closure suspects an ultrasound biomicroscopy study. Ophthalmology 115: 430−434. DOI: 10.1016/j.ophtha.2007.07.026. View in Article CrossRef Google Scholar
[18]	Wang, N., Ouyang, J., Zhou, W., et al. (2000). Multiple patterns of angle closure mechanisms in primary angle closure glaucoma in Chinese. Zhonghua Yan Ke Za Zhi 36: 46−51. View in Article Google Scholar Scopus
[19]	Quigley, H.A. (2009). Angle-closure glaucoma-simpler answers to complex mechanisms: LXVI Edward Jackson Memorial Lecture. Am. J. Ophthalmol. 148: 657−669. DOI: 10.1016/j.ajo.2009.08.009. View in Article CrossRef Google Scholar
[20]	Baskaran, M., Yang, E., Trikha, S., et al. (2017). Residual angle closure one year after laser peripheral iridotomy in primary angle closure suspects. Am. J. Ophthalmol. 183: 111−117. DOI: 10.1016/j.ajo.2017.08.016. View in Article CrossRef Google Scholar
[21]	Koh, V., Keshtkaran, M.R., Hernstadt, D., et al. (2019). Predicting the outcome of laser peripheral iridotomy for primary angle closure suspect eyes using anterior segment optical coherence tomography. Acta Ophthalmol. 97: e57−e63. DOI: 10.1111/aos.13822. View in Article CrossRef Google Scholar Scopus
[22]	Lee, R.Y., Kasuga, T., Cui, Q.N., et al. (2013). Association between baseline angle width and induced angle opening following prophylactic laser peripheral iridotomy. Invest. Ophthalmol. Vis. Sci. 54: 3763−3770. DOI: 10.1167/iovs.13-11597. View in Article CrossRef Google Scholar Scopus
[23]	Sung, K.R., Lee, K.S., and Hong, J.W. (2015). Baseline anterior segment parameters associated with the long-term outcome of laser peripheral iridotomy. Curr. Eye Res. 40: 1128−1133. DOI: 10.3109/02713683.2014.986334. View in Article CrossRef Google Scholar Scopus
[24]	Masoodi, H., Jafarzadehpur, E., Esmaeili, A., et al. (2014). Evaluation of anterior chamber angle under dark and light conditions in angle closure glaucoma: An anterior segment OCT study. Cont. Lens Anterior Eye. 37: 300−304. DOI: 10.1016/j.clae.2014.04.002. View in Article CrossRef Google Scholar Scopus
[25]	Nolan, W.P., See, J.L., Chew, P.T., et al. (2007). Detection of primary angle closure using anterior segment optical coherence tomography in Asian eyes. Ophthalmology 114: 33−39. DOI: 10.1016/j.ophtha.2006.05.073. View in Article CrossRef Google Scholar
[26]	Jiang, Y., Wang, W., Wang, L., et al. (2021). Association of anterior segment parameters and 5-year incident narrow angles: findings from an older Chinese population. Br. J. Ophthalmol. 105: 970−976. DOI: 10.1136/bjophthalmol-2020-315852. View in Article CrossRef Google Scholar
[27]	Wilensky, J.T., Kaufman, P.L., Frohlichstein, D, et al. (1993). Follow-up of angle-closure glaucoma suspects. Am. J. Ophthalmol. 115: 338−346. DOI: 10.1016/S0002-9394(14)73585-8. View in Article CrossRef Google Scholar Scopus
[28]	Friedman, D.S., Chang, D.S., Jiang, Y., et al. (2019). Darkroom prone provocative testing in primary angle closure suspects and those with open angles. Br. J. Ophthalmol. 103: 1834−1839. DOI: 10.1136/bjophthalmol-2018-313362. View in Article CrossRef Google Scholar Scopus
[29]	Harris, L.S., and Galin, M.A. (1972). Prone provocative testing for narrow angle glaucoma. Arch. Ophthalmol. 87: 493−496. DOI: 10.1001/archopht.1972.01000020495001. View in Article CrossRef Google Scholar
[30]	Ozaki, M., Nongpiur, M.E., Aung, T., et al. (2012). Increased lens vault as a risk factor for angle closure: Confirmation in a Japanese population. Graefes. Arch. Clin. Exp. Ophthalmol. 250: 1863−1868. DOI: 10.1007/s00417-012-2011-y. View in Article CrossRef Google Scholar Scopus
[31]	Moghimi, S., Vahedian, Z., Zandvakil, N., et al. (2014). Role of lens vault in subtypes of angle closure in Iranian subjects. Eye 28: 337−343. DOI: 10.1038/eye.2013.296. View in Article CrossRef Google Scholar Scopus
[32]	Wang, Z., Chung, C., Lin, J, et al. (2016). Quantitative measurements of the ciliary body in eyes with acute primary-angle closure. Invest. Ophthalmol. Vis. Sci. 57: 3299−3305. DOI: 10.1167/iovs.16-19558. View in Article CrossRef Google Scholar Scopus
[33]	Tan, G.S., He, M., Zhao, W., et al. (2012). Determinants of lens vault and association with narrow angles in patients from Singapore. Am. J. Ophthalmol. 154: 39−46. DOI: 10.1016/j.ajo.2012.01.015. View in Article CrossRef Google Scholar Scopus
[34]	Ang, M., Baskaran, M., Werkmeister, R.M., et al. (2018). Anterior segment optical coherence tomography. Prog. Retin. Eye Res. 66: 132−156. DOI: 10.1016/j.preteyeres.2018.04.002. View in Article CrossRef Google Scholar Scopus
[35]	Sakata, L.M., Lavanya, R., Friedman, D.S., et al. (2008). Assessment of the scleral spur in anterior segment optical coherence tomography images. Arch. Ophthalmol. 126: 181−185. DOI: 10.1001/archophthalmol.2007.46. View in Article CrossRef Google Scholar Scopus
[36]	Wanichwecharungruang, B., Pattanapongpaiboon, W., Kongsomboon, K., et al. (2022). Diagnostic performance of anterior segment optical coherence tomography in detecting plateau iris. BMJ Open Ophthalmol. 7: e000931. DOI: 10.1136/bmjophth-2021-000931. View in Article CrossRef Google Scholar Scopus
[37]	Peng, P.H., Nguyen, H., Lin, H.S., et al. (2011). Long-term outcomes of laser iridotomy in Vietnamese patients with primary angle closure. Br. J. Ophthalmol. 95: 1207−1211. DOI: 10.1136/bjo.2010.181016. View in Article CrossRef Google Scholar Scopus

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Yuan Y., Yang S., Wang W., et al., (2023). Prediction of angle closure after laser peripheral iridotomy: The fourteen-year Zhongshan Angle Closure Prevention trial. The Innovation Medicine 1(3), 100033. https://doi.org/10.59717/j.xinn-med.2023.100033

Yuan Y., Yang S., Wang W., et al., (2023). Prediction of angle closure after laser peripheral iridotomy: The fourteen-year Zhongshan Angle Closure Prevention trial. The Innovation Medicine 1(3), 100033. https://doi.org/10.59717/j.xinn-med.2023.100033

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Prediction of angle closure after laser peripheral iridotomy: The fourteen-year Zhongshan Angle Closure Prevention trial

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Prediction of angle closure after laser peripheral iridotomy: The fourteen-year Zhongshan Angle Closure Prevention trial

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