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Argon laser iridoplasty

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Last updated: February 21st, 2022

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Summary of Evidence

Acute Angle Closure

Argon laser peripheral iridoplasty significantly is more effective than conventional systemic medications in reducing IOP levels in acute PACG in eyes not suitable for immediate laser peripheral iridotomy within the first 2 hours from the initiation of treatment.{Lam DS, Lai JS, Tham CC, Chua JK, Poon AS. Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma : a prospective, randomized, controlled trial. Ophthalmology. 2002 Sep;109(9):1591-6.}

Chronic Angle Closure

Argon laser iridoplasty may be no more clinically effective than comparators in the management of chronic angle closure. Despite a potential positive impact on anterior chamber morphology, its use in clinical practice in treating people with chronic angle closure is not supported by the results of trials published to date.{Bayliss JM, Ng WS, Waugh N, Azuara-Blanco A. Laser peripheral iridoplasty for chronic angle closure. Cochrane Database Syst Rev. 2021 Mar 23;3(3):CD006746.}

Evidence

1. Background

Systematic Review

2007 Ritch et.al.

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2007
Systematic Review

Review of Argon laser peripheral iridoplasty.{Ritch R, Tham CC, Lam DS. Argon laser peripheral iridoplasty (ALPI): an update. Surv Ophthalmol. 2007 May-Jun;52(3):279-88.}

Ritch et.al.
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2. Efficacy

2.1 Acute angle closure

Clinical Trial

2002 Lam et.al.

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2002
Clinical Trial

Argon laser peripheral iridoplasty significantly is more effective than conventional systemic medications in reducing IOP levels in acute PACG in eyes not suitable for immediate laser peripheral iridotomy within the first 2 hours from the initiation of treatment.{Lam DS, Lai JS, Tham CC, Chua JK, Poon AS. Argon laser peripheral iridoplasty versus conventional systemic medical therapy in treatment of acute primary angle-closure glaucoma : a prospective, randomized, controlled trial. Ophthalmology. 2002 Sep;109(9):1591-6.}

  • Randomized controlled trial of ALIP vs systemic medical therapy (acetazolamide+/- mannitol) in patients with at acute primary angle closure glaucoma when immediate laser peripheral iridotomy is neither possible nor safe. (73 eyes of 64 patients).
  • Findings:
    • The ALPI-treated group had statistical significantly lower IOP levels than the medically treated group at 15 minutes, 30 minutes, and 1 hour after the start of treatment.
    • The difference became statistically insignificant from 2 hours onward

Lam et.al.
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2.2 Chronic angle closure

Systematic Review

2021 Bayliss et.al. (Cochrane review)

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2021
Systematic Review

Argon laser iridoplasty may be no more clinically effective than comparators in the management of chronic angle closure. Despite a potential positive impact on anterior chamber morphology, its use in clinical practice in treating people with chronic angle closure is not supported by the results of trials published to date.{Bayliss JM, Ng WS, Waugh N, Azuara-Blanco A. Laser peripheral iridoplasty for chronic angle closure. Cochrane Database Syst Rev. 2021 Mar 23;3(3):CD006746.}

  • Analysis of 4 RCTs involving 276 eyes of 252 participants.

Bayliss et.al. (Cochrane review)
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Clinical Trial

2016 Narayanaswamy et.al.

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2016
Clinical Trial

Argon laser peripheral iridoplasty was associated with higher failure rates and lower IOP reduction compared with prostaglandin analogue therapy in eyes with persistent appositional angle closure and raised IOP after laser iridotomy.{Narayanaswamy A, Baskaran M, Perera SA, Nongpiur ME, Htoon HM, Tun TA, Wong TT, Goh D, Su DH, Chew PT, Ho CL, Aung T. Argon Laser Peripheral Iridoplasty for Primary Angle-Closure Glaucoma: A Randomized Controlled Trial. Ophthalmology. 2016 Mar;123(3):514-21.}

  • Randomized controlled trial of ALIP vs medical therapy (travoprost) in patients with at least 180° of persistent appositional angle closure and intraocular pressure > 21 mmHg (51 eyes of 40 patients).
  • Findings (1-year)
Outcomes (1-year) ALIP Medical therapy
Complete success {IOP ≤21 mmHg without medication} 35.0% 85.0%
Qualified success (IOP ≤21 mmHg with medication) 35.0% 7.5%
IOP decrease 4.9 mmHg 6.1 mmHg
Failure rate 30.0% 7.5%

Narayanaswamy et.al.
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References

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