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Indian Journal of Clinical and Experimental Ophthalmology

Manipulative Gonioscopy as a predictor of angle opening– post Nd-YAG laser Iridotomy in primary angle closure suspects (PACS) patients

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Author Details: Sundip Shenoy, Dinesh P, Pavan Kumar Reddy, Pranessh Ravi

Volume : 3

Issue : 1

Online ISSN : 2395-1451

Print ISSN : 2395-1443

Article First Page : 15

Article End Page : 19


Background: PACS (primary angle closure suspects) continue to pose a diagnostic and therapeutic dilemma. PACS being converted to PACG as the disease evolves in the long run leads to irreversible blindness; hence the importance of screening with gonioscope to see which patients will improve with laser peripheral iridotomy (LPI).
Objective: To assess the effectiveness of routine manipulative gonioscopy as a tool in order to predict angle opening after Nd-YAG laser iridotomy in PACS patients.
Methods: Fifty patients having PACS were enrolled in the prospective observational interventional study. Main outcome measure were effect on IOP, effectiveness of manipulative gonioscopy with regard to angle opening and Van Hericksin predicting angle changes. Manipulative gonioscopy and Peripheral laser iridotomy was done. Wilcoxon signed rank was used to find the significance of study parameters.
Results: Seventy four percent were females with males forming 26% of the study. Mean age was 65 ± 5.16 years. Comparison of Shaffers grading pre and post intervention in superior quadrant showed P value 0.020(suggestive of significance), inferior quadrant showed p<0.001 which was significant. Van Herick’s grading pre and post intervention in the temporal quadrant showed P value 0.005 and in the nasal quadrant showed P value of 0.001 which is strongly significant and correlates with gonioscopic findings.
Conclusion: Study confirms that laser peripheral iridotomy increases peripheral chamber angle as predicted by manipulative gonioscopy in majority of cases prior to the intervention which correlates with schaffer/Van Herick’s grading. Laser peripheral iridotomy to all patients with PACS requiresproper evaluation as some cases have no effect on peripheral anterior chamber depth post LPI.

Manipulative Gonioscopy, Glaucoma, Primary angle closure suspect (PACS), Dynamic Gonioscopy