Laser Peripheral Iridotomy Complications Differ By Race

Ophthalmologist examining patient's eyes
Ophthalmologist examining patient’s eyes
Patients who self-identified as having Black race experienced greater intraocular pressure elevation and iritis following the glaucoma procedure than other groups.

Elevated preprocedural intraocular pressure (IOP) and Black race are risk factors for increased IOP and iritis in primary angle closure suspect (PACS) patients who have received laser peripheral iridotomy (LPI), according to a report published in Journal of Glaucoma.  

The retrospective study examined 1485 participants wjp received LPI between 2010 and 2018 at the University of Pennsylvania Department of Ophthalmology older than age 18 and have had a prior diagnosis of anatomical narrow angle or PACS. LPI procedures were conducted with neodymium-doped yttrium-aluminum-garnet lasers (Nd:YAG LPI) or sequential argon and neodymium-doped yttrium-aluminum-garnet lasers (Nd:YAG + Argon LPI). Researchers examined participants’ average IOP 30 days before procedure, within 1-hour post procedure, incidence of newly developed iritis within 30 days post procedure, and laser type and energy using univariate and multivariate regression analysis. Age, sex, race, surgeon, autoimmune disease, and history of diabetes and hypertension were also accounted for in the results.

Of the 1485 participants in this study, the mean age was 66.8 years and 43.4% self-identified as having Black race while 45.6% self-identified as having non-Hispanic White race. Among the groups, the incidence of IOP elevation following LPI was 9.3% and iritis was 2.6%, respectively. When race was examined as a risk factor for IOP and iritis, researchers found the odds ratio to be 2.08 and 5.07, respectively, when compared to white counterparts. Additionally, higher IOP prior to LPI was found to be a risk factor for elevated LPI after the procedure.

Laser type and energy was not found to be a risk factor in this study, which is not consistent with the current literature and further research is needed to clarify these results before they can be considered in clinical practice. 

These results suggest that patients who are Black may require management with “additional medications to mitigate the effects of immediate IOP elevation and decrease the incidence of iritis,” the researchers report.

Reference

Adetunji MO, Meer E, Whitehead G, et al. Self-identified Black race as a risk factor for intraocular pressure elevation and iritis following prophylactic laser peripheral iridotomy. J Glaucoma. 2022;31(4):218-223. doi:10.1097/ijg.0000000000001995