Efficacy of Nd:YAG Laser Peripheral Iridotomy in Primary Angle Closure Glaucoma and Its Role in Prophylactic Management of Fellow Eyes

Background: Primary angle closure glaucoma (PACG) is a major cause of irreversible blindness, particularly in Asian populations. Nd:YAG laser peripheral iridotomy (PI) is the primary intervention aimed at relieving pupillary block and preventing disease progression.

Objectives: To evaluate the efficacy of Nd:YAG laser peripheral iridotomy in controlling intraocular pressure (IOP) in primary angle closure disease, to assess its prophylactic role in fellow eyes, and to analyze post‑procedure anatomical changes and complications.

Methods: This prospective study included 100 patients with primary angle closure disease managed at a tertiary care center. Detailed ophthalmic evaluation, including Goldmann applanation tonometry and gonioscopy, was performed. Nd:YAG laser peripheral iridotomy was carried out in all affected eyes and 82 fellow eyes, with a follow‑up period of six months.

Results: Females constituted 73% of the study population, with most patients aged 40–60 years. Improvement of one or more Shaffer’s grades was observed in the majority of eyes. Good IOP control with stable or improved visual acuity was achieved in 92.2% of primary angle closure eyes and 71.4% of PACG eyes. All prophylactically treated fellow eyes maintained satisfactory IOP control. Transient IOP elevation and iris bleeding were the most common complications.

Conclusion: Nd:YAG laser peripheral iridotomy is a safe and effective treatment for primary angle closure disease. Early detection and timely intervention significantly improve anatomical outcomes and IOP control, thereby reducing the risk of visual morbidity