Abstract
PURPOSE: This study aimed to explore the possibility of the clinical application using anterior segment optical coherence tomography angiography (AS-OCTA)-guided laser peripheral iridotomy (LPI). METHODS: AS-OCT/OCTA was performed before LPI and at 1 hour, 1 day, and 1 week post-LPI. All the right eyes of patients with primary angle-closure suspect (PACS) were assigned to the AS-OCTA-guided group, in which the peripheral site with the sparsest iris vasculature on AS-OCTA images was selected for LPI. The left eyes underwent LPI in the slit lamp-guided group, where the site was chosen based on the presence of an iris crypt by clinicians using the slit lamp. The two groups were compared for the incidence of anterior chamber bleeding observed by the LPI operator, anterior chamber particle (ACP) index, mean angle opening distance (AOD750), and anterior chamber depth (ACD) measured from AS-OCT images, as well as the vessel density and perfusion area obtained from AS-OCTA images. RESULTS: A total of 30 patients with PACS were included in this study. The incidence of anterior chamber bleeding during LPI was 13.33% in the AS-OCTA-guided group, compared with 43.33% in the slit lamp-guided group (P = 0.010). The prominent difference was observed 1 hour after LPI, with the AS-OCTA-guided group showing significantly lower vessel density (P = 0.028), perfusion area (P = 0.003), and ACP (P = 0.004), but a larger AOD750 (P < 0.001) compared with the slit lamp-guided group. CONCLUSIONS: Utilizing AS-OCTA to guide the LPI procedure can significantly decrease the incidence of anterior chamber bleeding and mitigate inflammation. TRANSLATIONAL RELEVANCE: This study shows that the AS-OCTA-guided LPI procedure could bridge advanced imaging technology and clinical glaucoma management.