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Changes in Iridocorneal Angle and Anterior Chamber Structure in Eyes With Anatomically Narrow Angles

Laser Iridotomy Versus Pilocarpine

Mogil, Rachel S., MD*; Khezri, Nicole, MD; Ren, Ruojin, MD, PhD; Adleyba, Olga, MD; Abumasmah, Ramiz, MD; Ghassibi, Mark P., MD; Chien, Jason L., MD; Pearlstein, Adam, BS; Patthanathamrongkasem, Thipnapa, MD; Liebmann, Jeffrey M., MD; Ritch, Robert, MD; Park, Sung chul, MD*,§

doi: 10.1097/IJG.0000000000001097
Original Studies

Purpose: To compare the effects of laser iridotomy (LI) and pilocarpine on iridocorneal angle and anterior chamber structure in anatomically narrow angles (ANAs).

Materials and Methods: Temporal LI was performed 90 minutes after 2% pilocarpine administration in patients with occludable ANA. Swept-source optical coherence tomography B-scans of the anterior segment were obtained at baseline, 60 minutes after 2% pilocarpine administration, and 1 week after LI. Angle-opening distance (AOD), trabecular-iris surface area (TISA), and angle recess area (ARA) were measured at the temporal, superior, nasal, and inferior quadrants. Anterior chamber depth (ACD) and lens vault (LV) were also measured. AOD, TISA, ARA, ACD, and LV were compared among 3 time points: at baseline, 60 minutes after 2% pilocarpine administration, and 1 week after LI.

Results: Twenty-four eyes (24 patients; mean age, 55 y) were included. In all 4 quadrants and globally, AOD, TISA, and ARA increased from baseline after pilocarpine and after LI (all P<0.010). The increase in AOD, TISA, and ARA was greater after LI than after pilocarpine globally and in the temporal and superior quadrants (all P<0.040). ACD decreased and LV increased from baseline after pilocarpine (both P<0.001). Postpilocarpine anterior chambers were shallower with higher LV than post-LI (both P<0.016).

Conclusion: LI is more effective than pilocarpine in widening the iridocorneal angle without significant shallowing the anterior chamber in eyes with ANA.

*Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital (Lenox Hill Hospital)

Moise Safra Advanced Ocular Imaging Laboratory, Einhorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai

Bernard and Shirlee Brown Glaucoma Research Laboratory, Harkness Eye Institute, Columbia University Medical Center, New York

§Department of Ophthalmology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY

R.S.M. and N.K. contributed equally.

Presented in part at the Association for Research in Vision and Ophthalmology Annual Meeting, May 6, 2015, Denver, CO.

Supported by the Sy and Felicia Jacobs Charitable Fund of the Schwab Charitable, New York, NY (S.C.P.); Manhattan Eye, Ear, and Throat Hospital Glaucoma Education and Research Fund (#591601), New York, NY (S.C.P.); Michael and Francesca Freedman Research Fund of the New York Glaucoma Research Institute, New York, NY.

Disclosure: J.M.L.: Carl Zeiss Meditec, Topcon Inc., Alcon Laboratories, Allergan Inc., Diopsys Corporation, Glaukos Corporation, Heidelberg Engineering, Merz Pharmaceutical Inc., Optovue Inc., Quark Pharmaceuticals, SOLX Inc. The remaining authors declare no conflict of interest.

Reprints: Sung Chul Park, MD, Department of Ophthalmology, Manhattan Eye, Ear, and Throat Hospital (Lenox Hill Hospital), 210 East 64th Street, New York, NY 10065 (e-mail:

Received August 4, 2018

Accepted September 7, 2018

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