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To determine whether the temporal-superior or the nasal-superior iris area becomes thinner (more optimal) for laser peripheral iridotomy (LPI) after pilocarpine instillation in primary angle closure disease (PACD); and to identify an angle for optimal penetration of the laser beam. Iris thickness at 2 mm from the iris root in the preset scanning axes was measured using swept-source anterior segment optical coherence tomography before and 60 minutes after the instillation of pilocarpine 2% in one eye of 30 consecutive Japanese PACD patients with thick, dark brown iris. Iris thickness at 1:30 and 10:30 clock hour positions were evaluated in sagittal and oblique directions, resulting sagittal iris thickness (SIT) and minimum iris thickness (MIT) parameters, respectively. Compared to the baseline values, iris thickness decreased significantly (P &lt; .001) in both locations after pilocarpine instillation. Both before and after pilocarpine instillation the temporal-superior iris thickness was significantly smaller than the nasal-superior thickness (P ≤ .001). After pilocarpine instillation, the temporal-superior iris was significantly thinner in an approximately 13° angle direction temporal to the sagittal direction than in the sagittal direction (MIT: 0.322 mm; SIT: 0.346 mm, P &lt; .001). After pilocarpine instillation, the temporal-superior iris and an approximately 13° angle temporal to the sagittal direction may provide an optimal location and laser beam angle for LPI in PACD eyes.

seminars in ophthalmology

Effect of Topical Pilocarpine Instilled Before Laser Peripheral Iridotomy on Regional Iris Thickness in Primary Angle Closure Disease: A Swept-Source Anterior Segment Optical Coherence Tomography Pilot Study