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Impact of laser iridotomy on headache symptoms in angle-closure subjects

  • Glaucoma
  • Published:
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Abstract

Background

Migraine symptoms are frequently referred by glaucoma patients. Although most studies analyze headache in the acute setting of angle closure, many patients with chronic occludable angles also complain of headaches. The aim of this study was to determine the impact of laser peripheral iridotomy (LPI) on the magnitude and frequency of headache symptoms in patients with occludable angles.

Methods

Prospective cohort study. Patients with indication for prophylactic LPI due to occludable iridocorneal angle were included. Headache symptoms were assessed before and at least 4 weeks after LPI using the Headache Impact Test-6 (HIT-6) questionnaire. A HIT-6 score of ≥ 50 points was labeled as a clinically significant headache.

Results

Thirty-one subjects were included. Prophylactic LPI was performed in 60 eyes, as 2 patients were pseudophakic in the fellow eye. Baseline HIT-6 score was 59.9 ± 11.8, with over three quarters of these patients scoring higher than 50 points (n = 24). A statistically significant reduction in HIT-6 score was found after LPI treatment (45.4 ± 7.7, p < 0.01). Sub-analysis within the clinically symptomatic subjects disclosed a significant improvement after treatment in this group (baseline, 65.3 ± 6.2 vs post-LPI 46.2 ± 8.3, p < 0.01), with a high baseline HIT-6 score being predictive of a symptomatic improvement after LPI (χ2(8) = 15.3, p = 0.001). This is mimicked from the patient’s perspective, as the two subjective questions after LPI, concerning pain intensity and frequency, report that 79.2% had a statistically significant improvement of the headaches.

Conclusions

Within our sample, the majority of patients with occludable angles had clinically relevant headaches. LPI provided symptomatic relief in the majority of those patients with high HIT-6 scores. Further studies are needed to explore the relationships between headache and angle anatomy.

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Author notes

  1. Filipa Jorge Teixeira and Filipa Caiado Sousa contributed equally to this work.

Authors and Affiliations

  1. Ophthalmology Department, Hospital de Santa Maria, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal

    Filipa Jorge Teixeira, Filipa Caiado Sousa, Nuno Pinto Ferreira, Raquel Esteves Marques, Rafael Correia Barão & Luís Abegão Pinto

  2. Clínica Universitária de Oftalmologia, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

    Filipa Jorge Teixeira, Filipa Caiado Sousa, Nuno Pinto Ferreira, Raquel Esteves Marques, Rafael Correia Barão & Luís Abegão Pinto

  3. Centro de Estudos das Ciências da Visão, Universidade de Lisboa, Lisbon, Portugal

    Luís Abegão Pinto

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  1. Filipa Jorge Teixeira
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Correspondence to Luís Abegão Pinto.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Filipa Jorge Teixeira and Filipa Caiado Sousa should be considered joint first authors.

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Teixeira, F.J., Sousa, F.C., Ferreira, N.P. et al. Impact of laser iridotomy on headache symptoms in angle-closure subjects. Graefes Arch Clin Exp Ophthalmol 258, 1771–1777 (2020). https://doi.org/10.1007/s00417-020-04672-1

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  • DOI: https://doi.org/10.1007/s00417-020-04672-1

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