Yag Laser Versus Sequential Yag-Argon for Peripheral Iridotomy in Acute Angle Closer Glaucoma

Acute angle closer glaucoma accounts for 10% to 20% of all glaucoma cases. Laser peripheral iridotomy is considered the standard treatment modality for predisposed subjects it can be performed with Argon, YAG or both. The combined method provides the benefits of each laser while minimizing their respective drawbacks. This is a prospective study over a period of 18 months on 50 eyes: 25 patients with acute angle closer glaucoma: for each patient, a peripheral iridotomy with YAG laser alone on one eye and sequential iridotomy with Argon laser then YAG in the other eye. The results showed that the YAG only technique is less painful (2.5/10 versus 7.5/10), needs less time (5 minutes) and uses less energy than the combined method. Meanwhile the Argon-YAG technique showed less complication for dark irises. Ho and Fan [1] did a combined technique for iridotomy in 20 eyes with dark irises. They performed it with only a mean of 4 YAG impacts versus 12 in our study for the combined technique group. In term of complications, they had a 10% hyphema and endothelial opacity; we had none of both complications in our combined technique cases. The sequential method remains the most widely used, it theoretically offers an advantage over the YAG laser only in the treatment of darker irises with less complications. Meanwhile the YAG only technique is better for the comfort of the patient, it is quicker, brings less pain and delivers less energy to the iris.