Management of patients with narrow angles and acute angle‐closure glaucoma

Abstract

Background: Acute closure of the anterior chamber angle can have catastrophic consequences for vision when it occurs in an unsupervised situation. Visual debilitation is much less likely to result when angle-closure occurs in a well-controlled environment that allows appropriate management. Therefore, it is desirable for optometrists to undertake a complete ocular health assessment, including mydriatic fundus examination, on patients who have narrow anterior chamber angles, provided that appropriate precautions and procedures are followed. Case report: We report on the case of a 59-year-old white female whose anterior chamber angles closed in response to mydriatic drops instilled during an optometric examination. Her optic discs and visual field results from before and four years after the angle-closure attack do not show any significant changes. Conclusion: We conclude that the optimal standard of care for patients presenting to an optometric practice, and who are subsequently found to have narrow anterior chamber angles, includes pupillary dilatation to allow stereoscopic visualisation of the optic nerve head. Precautions must be followed to ensure that, in the unlikely event of an ensuing angle-closure episode, the attack occurs under clinically supervised conditions. (Clin Exp Optom 1998; 81: 6: 255-266)

Using the Electroretinogram to Understand How Intraocular Pressure Elevation Affects the Rat Retina

“…The primary outflow pathway is through the trabecular meshwork, with a small percentage (10%) exiting via the uveoscleral route. Thus, any resistance in the outflow (e.g., blockage in trabecular meshwork) or a change in the anatomic relationship between the pupillary margin and the lens will result in IOP elevation [40–42]. …”

Low-dose transscleral cyclophotocoagulation with subsequent phacoemulsification in the treatment of prolonged acute primary angle closure

“…17 18 22 The mechanisms of this phenomenon were thought to be caused by the sudden decrease of IOP due to ciliary body shutdown induced by the prolonged attack, and alteration in the capillary permeability after ischaemia of ciliary body. [23][24][25] And it was reported that the suppression of aqueous humour may persist for 1 week in most cases after the halt on aqueous suppressants, thus causing the transient IOP reduction. 17 In the present study, we did not find SCE in our patients prior LDTSCP, and we found that eyes with more audible 'bursts' and CBD had more severe SCE and greater levels of IOP reduction.…”

Anterior Chamber Paracentesis Facilitates Laser Peripheral Iridotomy and Restores Vision in Mild-to-moderate Acute Primary Angle-closure Glaucoma

“…5 Immediate intravenous administration of mannitol, a hyperosmotic agent, is the standard treatment. 6 However, alternative treatments should be considered if the patient is at high risk of a reaction to mannitol, such as congestive heart failure, chronic renal insufficiency, or other systemic illnesses. 7e9 In order to relieve the symptoms and lower IOP as quickly as possible, immediate anterior chamber paracentesis (ACP) has recently been suggested as an alternative treatment for patients with acute PACG.…”