Early intraocular pressure change after peripheral iridotomy with ultralow fluence pattern scanning laser and Nd:YAG laser in primary angle-closure suspect: Kowloon East Pattern Scanning Laser Study Report No. 3

Aim: To assess the role of sequential treatment of paracentesis followed by laser peripheral iridotomy in acute primary angle closure.Methods: This was a prospective interventional study of acute primary angle closure in Indonesian patients. All eyes underwent paracentesis immediately after admission to reduce the intraocular pressure, followed by laser peripheral iridotomy on the following day to relieve pupillary blockade. A comprehensive eye examination was performed. The criterion for success was intraocular pressure <21 mm Hg with or without glaucoma medication. Risk factors assessed were age, duration of acute symptoms, presenting intraocular pressure, intraocular pressure response to paracentesis and to laser peripheral iridotomy, anterior chamber depth, and extent of peripheral anterior synechiae.Results: Forty five eyes of 45 patients with acute primary angle closure were recruited, of whom 38 were women. The duration of symptoms ranged from 2 to 30 days (median, 14 days). The mean extent of peripheral anterior synechiae was 7.7 clock hours (SD, 3.1 clock hours) and the mean presenting intraocular pressure was 55.9 mm Hg (SD, 13.4 mm Hg; range, 30.0-78.0 mm Hg). After paracentesis, the mean intraocular pressure decreased to 27.0 (SD, 12.8 mm Hg; range, 15.0-54.0 mm Hg). After laser peripheral iridotomy, the mean intraocular pressure was 24.0 mm Hg (SD, 15.2 mm Hg; range 8.0-40.0 mm Hg). Success was achieved in 21 eyes and the variable risk factor influencing success was extent of peripheral anterior synechiae.Conclusion: The success rate for sequential treatment was 47% of affected eyes and was determined mostly by the extent of peripheral anterior synechiae.

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Faculty Opinions recommendation of Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717955061.793488620 ◽

2013 ◽

Author(s):

Brian Ang

Keyword(s):

Randomized Trial ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Initial Management ◽

Acute Primary Angle Closure ◽

Primary Angle Closure ◽

Peripheral Iridotomy

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Faculty Opinions recommendation of Initial management of acute primary angle closure: a randomized trial comparing phacoemulsification with laser peripheral iridotomy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717955061.793467761 ◽

2012 ◽

Author(s):

Steve A Arshinoff

Keyword(s):

Randomized Trial ◽

Angle Closure ◽

Laser Peripheral Iridotomy ◽

Initial Management ◽

Acute Primary Angle Closure ◽

Primary Angle Closure ◽

Peripheral Iridotomy

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Polypharmacy-associated potential contraindications of drug prescriptions in patients with primary angle closure disease in a real-world setting

Journal of Pharmaceutical Health Care and Sciences ◽

10.1186/s40780-021-00196-w ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Fumiaki Tanaka ◽

Naoki Shibatani ◽

Kazumi Fujita ◽

Hiroaki Ikesue ◽

Satoru Yoshimizu ◽

...

Keyword(s):

Intraocular Pressure ◽

Anterior Chamber ◽

Anterior Chamber Depth ◽

Japanese Patients ◽

Median Number ◽

Angle Closure ◽

Primary Angle Closure ◽

Primary Angle Closure Glaucoma ◽

Number Of Patients ◽

Multiple Drugs

Abstract Background Primary angle closure disease (PACD) is a type of glaucoma in which the intraocular pressure (IOP) is increased because of the blockage of the anterior chamber angle. Medications contraindicated for patients with PACD, such as anticholinergics, cause mydriasis, and can elevate IOP. However, anticholinergics are currently contraindicated only for primary angle closure glaucoma (PACG) in Japanese package inserts. In this study, we investigated the prescription status of medications contraindicated for PACD, such as anticholinergics, in patients with PACD scheduled for eye surgeries. Methods Forty-three Japanese patients diagnosed with PACD at Kobe City Eye Hospital, Japan, and scheduled hospitalization for eye surgeries between December 2017 and July 2018, were included. Data, including sex, age, diagnosis, IOP, anterior chamber depth, and patients’ regular medications prior to hospitalization, were collected for each patient from the electronic medical records. Results The number of patients with chronic primary angle closure (CPAC) and acute primary angle closure (APAC) was 35 (81.4%) and 8 (18.6%), respectively. Among all the 43 patients with PACD, 8 (18.6%) received 15 medications that are potentially contraindicated for PACD by non-ophthalmologist. According to medication categories, benzodiazepine hypnotics were the most commonly prescribed. Among the 8 patients with APAC, 2 (25.0%) had routinely received medications contraindicated for PACD. The median number of all kinds of prescriptions on the day of hospitalization was significantly higher for patients who received medications contraindicated for PACD than for those who did not receive them (p = 0.010). Conclusions About 20% of patients with PACD received medications potentially contraindicated for PACD, such as anticholinergics. Attention should be paid to patients prescribed multiple drugs for adverse events, such as increase in intraocular pressure.

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