None listed
Conditions
Brief summary
Acute primary angle closure is a sight-threatening ocular disease. In acute primary angle closure , sudden sufficiently extensive occlusion of the outflow angle by iris tissue, results in an abrupt rise in the intraocular pressure. Patients with acute primary angle-closure usually have blurred vision, ocular pain, nausea, vomiting and headache. The treatment for acute primary angle closure aims at rapidly reducing intraocular pressure , so as to relieve unpleasant symptoms and also to prevent further irreversible ocular tissue damage, then, treatment in the next step aims to prevent recurrence of the acute disease and also to prevent progression to chronic angle closure glaucoma. Traditionally, the treatment for acute primary angle closure involves lowering the intraocular pressure with both systemic and topical medications and then subsequently relieving the papillary block by laser peripheral iridotomy. But this conventional management algorithm has many limitations. Aung et al reported that 58.1% of Asian eyes with acute primary angle closure, treated with medications in the conventional manner followed by laser iridotomy, subsequently developed increase in intraocular pressure. This findings raised the suspicion the traditionally treatment for acute primary angle closure. Therefore, in recent years, a number of trials have been undertaken with the hope of moving one step closer to the ideal treatment algorithm for acute primary angle closure . So, a pilot study had proposed anterior chamber paracentesis as an adjunctive therapy in the management of acute primary angle closure. But, to date, only few reports are available that focus on anterior chamber paracentesis in the management of acute primary angle closure . Herein, we conducted a prospective, randomized, controlled study to evaluate the safety and efficacy of immediate anterior chamber paracentesis in the management of acute primary angle closure not amenable to immediate laser peripheral iridotomy.
Interventions
Before anterior chamber paracentesis, the following topical medications were given to the involved eye: 1 drop of 0.5% proxymetacaine hydrochloride every minute for 3 minutes, 1 drop of gatifloxacin (3mg/ml), and an application of antiseptic (5% povidone iodine) for 3 minutes. The paracentesises were performed with aseptic techniques at the slit-lamp biomicroscope. A sterile 15° slit knife was used to make a safe-sealing stab incision in the temporal quadrant of the peripheral cornea to relieve
Before anterior chamber paracentesis, the following topical medications were given to the involved eye: 1 drop of 0.5% proxymetacaine hydrochloride every minute for 3 minutes, 1 drop of gatifloxacin (3mg/ml), and an application of antiseptic (5% povidone iodine) for 3 minutes. The paracentesises were performed with aseptic techniques at the slit-lamp biomicroscope. A sterile 15° slit knife was used to make a safe-sealing stab incision in the temporal quadrant of the peripheral cornea to relieve aqueous (~0.05 ml) from the anterior chamber.After anterior chamber paracentesis, the following topical medications were administered: 0.5% proxymetacaine hydrochloride once, gatifloxacin (3mg/ml) 1drop after paracentesis and then two hourly for 1day and then six times per day, 4% pilocarpine 1 drop after paracentesis and then every 10 minutes for 1 hours and then two hourly until definitive laser peripheral iridotomy was performed (within 48 hours from paracentesis), 0.5% timolol maleate gellan 1 drop after paracentesis and then once daily. In addition to topical medications, each patient also received i slows intravenous 20% mannitol (200ml) over 1 hour and then methazolamide tablets, 100mg three times daily for 1 day.
Sponsors
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center,Sun Yat-sen University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
35 Years to 81 Years
Healthy volunteers
No
Inclusion criteria
(1) Intraocular pressure levels of 50 mmhg or more (by Goldman applanation tonometry);(2) ability to give informed consent and to cooperate for slit-lamp anterior chamber paracentesis procedure; (3) Duration of attack, as determined by the onset of symptoms, of 72 hours or less; (4) no medical contraindication to systemic acetazolamide or mannitol treatment; (5) the cornea edema rendering immediate laser peripheral iridotomy unsafe.
Exclusion criteria
(1) patients who had received antiglaucomatous treatment before being seen by the authors; (2) the eye with acute primary angle closure had previous intraocular surgery; (3) the eye with acute primary angle closurewas patient’s only eye; (4) the eye have other previous ophthalmic disorders that may have a persistent effect on the structure or function of the drainage angle.
Outcome results
None listed