Regular articleInterventions for angle-closure glaucoma: An evidence-based update☆
Section snippets
Search strategy for the identification of studies
A comprehensive search was conducted to identify all relevant randomized clinical trials, controlled clinical trials, prospective noncontrolled clinical trials, and retrospective cases series with >50 cases of AAC or PAC with or without GON reported with the primary objective of evaluating interventions for the treatment of AAC, AACG, PAC, or PACG. Reasons for study exclusion included case series with <50 reported cases and studies of glaucoma patients that included cases but did not report the
Summary of evidence
Nine randomized clinical trials assessed treatment techniques for all forms of angle closure (AAC/AACG, n = 3; PAC/PACG, n = 3; contralateral eye prophylaxis, n = 2; and mixed population, n = 1). Outcomes assessed included long-term control of IOP, changes in VA, visual field progression, and progression of peripheral anterior synechiae. Most studies were not masked, the sample sizes varied from 12 to 52 patients, and the follow-up time ranged from 3 weeks to 3 years. Two trials—by Goins et al11
Clinical recommendations
We have surveyed the findings of the literature of studies that evaluated interventions for AAC, PAC, and prophylactic treatment of the fellow eye in AAC patients. Few randomized clinical trials have been conducted in this field, and we therefore selected a mixture of epidemiologic study designs: randomized clinical trials, controlled clinical trials, and large retrospective case series (n > 50). The overall quality of the literature was poor. Only one of the nine randomized clinical trials
Conclusions
The literature is often difficult to interpret because mixed populations have been studied and because treatments are not necessarily equally effective for AAC and PAC. Researchers have frequently included a mixture of angle-closure types,11 and often only combined results are reported. Furthermore, the diagnostic criteria for including patients in studies of angle closure have not been standardized, and there is a need to establish a uniform classification, as previously proposed.9 It is
Questions for review and CME credit request
The American Academy of Ophthalmology is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Academy designates this educational activity for a maximum of one hour in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Requests for CME credit must be made within one year of the date of
References (54)
- et al.
Acute primary angle-closurelong-term intraocular pressure outcome in Asian eyes
Am J Ophthalmol
(2001) Evidence-based ophthalmology series and content-based continuing medical education for the journal
Ophthalmology
(2000)- et al.
Immediate argon laser peripheral iridoplasty as treatment for acute attack of primary angle-closure glaucomaa preliminary study
Ophthalmology
(1998) - et al.
Trabeculectomy for acute primary angle closure
Ophthalmology
(2000) - et al.
NeodymiumYAG and argon laser iridotomy. Long-term follow-up in a prospective, randomized clinical trial
Ophthalmology
(1988) - et al.
Comparison of the intraocular pressure-lowering effect of latanoprost and timolol in patients with chronic angle closure glaucomaa preliminary study
Ophthalmology
(2000) - et al.
Effect of cataract surgery on intraocular pressure control in glaucoma patients
J Cataract Refract Surg
(2001) - et al.
Primary phacoemulsification for uncontrolled angle-closure glaucoma
J Cataract Refract Surg
(2000) - et al.
Acute primary angle closure in an Asian populationlong-term outcome of the fellow eye after prophylactic laser peripheral iridotomy
Ophthalmology
(2000) - et al.
Follow-up of angle-closure glaucoma suspects
Am J Ophthalmol
(1993)
A comparison of neodymiumYAG and argon laser iridotomies
Ophthalmology
The natural history and principles of treatment of primary angle-closure glaucoma
Am J Ophthalmol
Plateau iris syndromechanges in angle opening associated with dark, light, and pilocarpine administration
Am J Ophthalmol
Long-term clinical course of primary angle-closure glaucoma in an Asian population
Ophthalmology
Laser iridectomy. A controlled study comparing argon and neodymiumYAG
Ophthalmology
Argon laser iridotomy in the treatment of patients with primary angle-closure or pupillary block glaucomaa clinicopathologic study
Ophthalmology
Glaucoma in Mongolia. A population-based survey in Hövsgöl Province, northern Mongolia
Arch Ophthalmol
The prevalence of glaucoma in Chinese residents of Singaporea cross-sectional population survey of the Tanjong Pagar district
Arch Ophthalmol
Glaucoma in China. How big is the problem?
Br J Ophthalmol
Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey
Arch Ophthalmol
Rates of hospital admissions for primary angle closure glaucoma among Chinese, Malays, and Indians in Singapore
Br J Ophthalmol
Who needs an iridotomy?
Br J Ophthalmol
The definition and classification of glaucoma in prevalence surveys
Br J Ophthalmol
Argon laser pretreatment in NdYAG iridotomy
Ophthalmic Surg
Ocular hypertensioncorrelation of anterior chamber angle width and risk of progression to glaucoma
Eye
A randomised prospective comparison of operative peripheral iridectomy and NdYAG laser iridotomy treatment of acute angle closure glaucoma: 3 year visual acuity and intraocular pressure control outcome
Br J Ophthalmol
Cited by (125)
Headache in the Emergency Department: Avoiding Misdiagnosis of Dangerous Secondary Causes, An Update
2021, Emergency Medicine Clinics of North AmericaCitation Excerpt :They may additionally complain of nausea and vomiting. The typical physical examination reveals a mid-fixed dilated pupil with decreased visual acuity, injected conjunctiva, and corneal edema.81 Ocular pressures greater than 21 mm Hg are necessary to make the diagnosis, and IOP is typically 30 mm Hg or higher.
Effect of Anticoagulants and Surgeon-Related Factors on Short-term Outcomes of Laser Peripheral Iridotomy
2019, Ophthalmology GlaucomaBiometric Risk Factors for Angle Closure Progression after Laser Peripheral Iridotomy
2023, JAMA Ophthalmology
- ☆
Manuscript no. 220530
Supported by the Robert E. McCormick Scholar Award from Research to Prevent Blindness, New York, NY (DSF).