Immediate Anterior Chamber Paracentesis with a 30-Gauge Needle for Acute Primary Angle Closure

Abstract

Background: Primary angle-closure glaucoma (PACG) is more common among Asians than among Caucasians. Acute primary angle closure (APAC) is a serious associated complication in PACG patients. When conventional treatment fails, Anterior Chamber Paracentesis (ACP) can be performed to decrease IOP. Although slit knives are commonly used for performing ACP, other techniques can also be used to perform this procedure.

June consultation #3

“…Although this can be achieved with a standard paracentesis, a controlled lowering can be performed by inserting a 30-gauge needle unattached to a syringe into the anterior chamber; this maneuver generally lowers the IOP to the teens or high single digits and may permit distention and reestablishment of the drainage system (Paul Palmberg, personal communication). 14 If this maneuver is unsuccessful, canaloplasty combined with a microinvasive glaucoma surgery procedure can be tried to reinflate her drainage channels. We would suggest a stepped approach with canaloplasty and iStent (Glaukos) or Hydrus Microstent (Ivantis, Inc.) first.…”