The efficacy of laser peripheral iridotomy in pigmentary glaucoma

Purpose. Laser peripheral iridotomy (LPI) may help halt the progression of pigmentary glaucoma by relieving irido-zonular contact with subsequent pigment release and IOP elevation. In this retrospective study we assessed the efficacy of LPI in the treatment of pigmentary glaucoma. Methods. Thirty-seven eyes in 19 patients treated for pigmentary glaucoma between 1987 and 1994 were included. Patients who had LPI were compared to those who received medical treatment only. Eyes which had ALT or surgery were excluded. Mean follow-up was 35.6 months (range 6 to 84 months). Results. Thirteen eyes received LPI and 24 eyes received medical treatment only. In the LPI group, mean initial IOP of 27.4 mmHg decreased to mean IOP of 14.6 mmHg at last follow-up (46.7% reduction). In the medicine only group, mean initial IOP of 25.2 decreased to a mean IOP of 18.6 mmHg at last follow-up (26.1% reduction). The number of medicines required for IOP control at last follow-up was 1.7 in the medicine only group and 1.6 in the LPI group. Conclusion. While our results were not statistically significant due to our small sample size LPI does appear to help dramatically reduce IOP in pigmentary glaucoma patients when compared to those treated with medicine only. Its efficacy for the long term management of pigmentary glaucoma requires further study.