Acute primary angle closure–treatment strategies, evidences and economical considerations

Chan, Poemen P.; Pang, Jason Chun Sum; Tham, Clement C.

doi:10.1038/s41433-018-0278-x

Cited by 67 publications

(63 citation statements)

References 66 publications

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“…Laser peripheral iridotomy is the rst-line therapy in eyes with primary angle-closure disease, [8] but eyes with APAC are unsuitable for immediate laser peripheral iridotomy because of corneal edema, iris hyperemia, and a shallow anterior chamber. [9,10] Topical and systemic IOP-lowering medications, which are used as a rst-line drug usually, involve a topical ß-blocker, topical miotic agent, carbonic anhydrase inhibitor, oral hyperosmotic agent, and intravenous hyperosmotic agent.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Brinzolamide in the Initial Management of Acute Primary Angle Closure in Chinese: a Randomized Controlled Trial

Chen

Peng²,

et al. 2021

Preprint

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Objective: Since comprehensive medication has an important role in the initial management of patients presenting with acute primary angle closure, it is necessary to analyze the effect of each drug on alleviating the disease. This study aimed to evaluate the intraocular pressure-lowering effect of brinzolamide in the sequential treatment of acute primary angle closure. Methods: In this randomized double-blind controlled trial, a total of 131 eyes of 125 consecutive patients who presented with their ﬁrst episode of acute primary angle closure were recruited and received sequential treatment. The patients were randomized to receive either brinzolamide or normal saline as a placebo. The primary outcomes were decreased intraocular pressure, success rate, and treatment time. Results: There was no statistically significant difference in the decreased level of intraocular pressure between the two groups at 6, 12, or 24 hours after the start of treatment (P-values were 0.526, 0.206, and 0.130, respectively). The success rate and treatment time were also not significantly different between the groups. No adverse side effects of brinzolamide were observed in the brinzolamide group. Conclusions: In patients with a first episode of acute primary angle closure, brinzolamide did not improve the effectiveness of the sequential treatment for reducing the intraocular pressure levels or shortening the treatment time within the ﬁrst 24 hours of initiating therapy.

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Section: Discussionmentioning

confidence: 99%

Efficacy of Brinzolamide in the Initial Management of Acute Primary Angle Closure in Chinese: a Randomized Controlled Trial

Chen

Peng²,

et al. 2021

Preprint

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“…Patients with acute primary angle closure (APAC) typically present with extremely high IOP of between 50 and 60 mm Hg 20 in comparison with primary open-angle glaucoma. Signs of focal ischemia in the eye, such as iris atrophy and glaucomflecken, have also been reported in up to half of all APAC patients.…”

Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Experimental Model of Acute Ocular Hypertension with Acute Angle Closure Characteristics

Chong

Busoy

Tan

et al. 2020

Trans. Vis. Sci. Tech.

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To describe a minimally invasive experimental model of acute ocular hypertension (OHT) with characteristics of acute angle closure (AAC). Methods: Adult C57/Bl6 mice (n = 31) were subjected to OHT in one eye using a modified circumlimbal suture technique that elevated intraocular pressure (IOP) for 30 minutes. Contralateral un-operated eyes served as controls. IOP, anterior segment optical coherence tomography, and fundus fluorescein angiography (FFA) were performed. The positive scotopic threshold response (pSTR) and a-wave and bwave amplitudes were also evaluated. Retinal tissues were immunostained for the retinal ganglion cell (RGC) marker RBPMS and the glial marker GFAP. Results: OHT eyes developed shallower anterior chambers and dilated pupils. FFA showed focal leakage in 32.2% of OHT eyes, but in none of the control eyes. pSTR was significantly reduced at week 1 in OHT eyes compared to control eyes (57.3 ± 7.2 μV vs. 106.9 ± 24.8 μV; P < 0.05), but a-and b-waves were unaffected. GFAP was upregulated in OHT eyes but not in control eyes or eyes that had been sutured without OHT. RGC density was reduced in OHT eyes after 4 weeks (3857 ± 143.8) vs. control eyes (4469 ± 176.0) (P < 0.05). Conclusions: Our minimally invasive model resulted in acute OHT with characteristics of AAC in the absence of non-OHT-related neuroinflammatory changes arising from ocular injury alone. Translational Relevance: This model provides a valuable approach to studying specific characteristics of a severe blinding disease in an experimental setting. Focal areas of ischemia were demonstrated, consistent with clinical studies of acute angle closure patients elsewhere, which may indicate the need for further research into how this could affect visual outcome in these patients.

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“…A signi cant proportion of patients with AAC do not respond adequately to medical treatment alone. In such cases, it is important understand how to perform surgery safely and effectively [14].…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcomes of Vitreous Needle Aspiration Combined With Phacoemulsification for Acute Angle Closure With Continuous High Intraocular Pressure-A Retrospective Analysis

Xiang¹,

Chen²,

Wang³

et al. 2020

Preprint

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Background: The management of acute angle closure combined with an extremely shallow anterior chamber and cataracts remains complex. This study evaluated a technique of vitreous needle aspiration combined with phacoemulsification for the treatment of acute angle closure with continuous high intraocular pressure (IOP).Methods: We retrospectively reviewed the results of vitreous needle aspiration combined with phacoemulsification in 17 eyes (17 patients) with acute angle closure with continuous high IOP and coexisting visually significant cataracts between September 2018 and April 2020 at the glaucoma unit of the affiliated Changshu Hospital of Xuzhou Medical University. The main outcomes were the best corrected visual acuity (BCVA), IOP, anterior chamber depth (ACD), number of anti-glaucoma medications, and surgery-associated complications.Results: There were no complications during phacoemulsification and a foldable acrylic intraocular lens was implanted in the capsular bag in all 17 patients. For all patients, vitreous needle aspiration was successful at the first attempt. The BCVA improved from 2.02±0.54 logMAR preoperatively to 0.73±0.57 logMAR postoperatively at the final examination (p<0.001). The mean IOP was 54.47±5.33 mmHg preoperatively and 15.59± 2.35 mmHg at the final examination (p<0.001), without any medication. The ACD was 1.70±0.16 mm (range, 1.17-1.94 mm) preoperatively and 3.35±1.51 mm at the final examination (p<0.001).Conclusions: Our vitreous needle aspiration technique can be performed safely in phacoemulsification for the management of acute angle closure with continuous high IOP.

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Acute primary angle closure–treatment strategies, evidences and economical considerations

Cited by 67 publications

References 66 publications

Efficacy of Brinzolamide in the Initial Management of Acute Primary Angle Closure in Chinese: a Randomized Controlled Trial

Efficacy of Brinzolamide in the Initial Management of Acute Primary Angle Closure in Chinese: a Randomized Controlled Trial

A Minimally Invasive Experimental Model of Acute Ocular Hypertension with Acute Angle Closure Characteristics

Surgical Outcomes of Vitreous Needle Aspiration Combined With Phacoemulsification for Acute Angle Closure With Continuous High Intraocular Pressure-A Retrospective Analysis

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