EC Microbiology

Introduction: Acute primary angle closure (APAC) is known to be a common ocular emergency that needs immediate treatment to avoid permanent complications like blindness. Narrow anterior chamber angle, older age, female sex, and Asian racial origin are all known to be predisposing factors for the development of Acute primary angle closure. The predictable power of these predisposing factors is, on the other hand, relatively weak, and many debates remain raised as only a relatively small part of the anatomically predisposed eyes consequently develops Acute primary angle closure.

Aim of Work: In this review, we will discuss management of acute glaucoma. Methodology: We did a systematic search for management of acute glaucoma using PubMed search engine (http://www.ncbi.nlm. nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles.

The terms used in the search were: acute glaucoma, angle closure glaucoma, management, treatment, ophthalmology.

Conclusion: Primary angle closure represents a wide spectrum of medical conditions, from a relatively benign anatomical variant to a painful and permanently blinding disease. In order for patients to receive appropriate management, they should first be correctly grouped into one of four groups: PACS, PAC, PACG, or AACC. Although there is limited evidence to confidently suggest any treatment modality in addition to serial gonioscopy in PACS, management of PAC, PACG, and AACC is considered extremely important to prevent or delay glaucomatous optic neuropathy. For many years, management has included pharmacological treatment and LPI as primary modalities. However, as cataract surgery has become a relatively safer, faster, and more affordable procedure, its role in the management of angle closure is coming to the forefront. Randomized clinical trials are required to detect those patients who will consequently benefit most from cataract extraction compared with LPI.

Keywords: Acute Glaucoma; Angle Closure Glaucoma; Management; Treatment; Ophthalmology

1. Lowe RF. “Aetiology of the anatomical basis for primary angle-closure glaucoma: biometrical comparisons between normal eyes and eyes with primary angle-closure glaucoma”. British Journal of Ophthalmology3 (1970): 151-169.
2. Klein BE., et al. “Prevalence of glaucoma. The Beaver Dam Eye Study”. Ophthalmology10 (1992): 1499-1504.
3. Arkell SM., et al. “The prevalence of glaucoma among Eskimos of northwest Alaska”. Archives of Ophthalmology4 (1987): 482- 485.
4. He M., et al. “Prevalence and clinical characteristics of glaucoma in adult Chinese: a population-based study in Liwan District, Guangzhou”. Investigative Ophthalmology and Visual Science7 (2006): 2782-2788.
5. Vijaya L., et al. “Six-year incidence of angle-closure disease in a South Indian population: The Chennai Eye Disease Incidence Study”. American Journal of Ophthalmology6 (2013): 1308-1315.
6. Teikari J., et al. “Incidence of acute glaucoma in Finland from 1973 to 1982”. Graefe’s Archive for Clinical and Experimental Ophthalmology5 (1987): 357-360.
7. Seah SK., et al. “Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey”. Archives of Ophthalmology11 (1997): 1436-1440.
8. He N., et al. “Comparison of Ciliary Body Anatomy between American Caucasians and Ethnic Chinese Using Ultrasound Biomicroscopy”. Current Eye Research4 (2016): 485-491.
9. Kumar RS., et al. “Confirmation of the presence of uveal effusion in Asian eyes with primary angle closure glaucoma: an ultrasound biomicroscopy study”. Archives of Ophthalmology12 (2008): 1647-1651.
10. Wilensky JT., et al. “Follow-up of angle-closure glaucoma suspects”. American Journal of Ophthalmology3 (1993): 338-346.
11. Thomas R., et al. “Five year risk of progression of primary angle closure suspects to primary angle closure: a population based study”. British Journal of Ophthalmology4 (2003): 450-454.
12. Quigley HA., et al. “The cost of glaucoma care provided to Medicare beneficiaries from 2002 to 2009”. Ophthalmology11 (2013): 2249-2257.
13. Friedman DS and Vedula SS. “Lens extraction for chronic angle-closure glaucoma”. Cochrane Database of Systematic Reviews 3 (2006): CD005555.
14. Huang G., et al. “Anterior chamber depth, iridocorneal angle width, and intraocular pressure changes after phacoemulsification: narrow vs open iridocorneal angles”. Archives of Ophthalmology10 (2011): 1283-1290.
15. Lam DS., et al. “Randomized trial of early phacoemulsification versus peripheral iridotomy to prevent intraocular pressure rise after acute primary angle closure”. Ophthalmology7 (2008): 1134-1140.
16. Tham CC., et al. “Phacoemulsification versus trabeculectomy in medically uncontrolled chronic angle-closure glaucoma without cataract”. Ophthalmology1 (2013): 62-67.
17. Barbosa DTQ., et al. “Clear lens extraction in angle-closure glaucoma patients”. International Journal of Ophthalmology3 (2013): 406-408.
18. Azuara-Blanco A., et al. “The effectiveness of early lens extraction with intraocular lens implantation for the treatment of primary angle closure glaucoma (EAGLE): study protocol for a randomized controlled trial”. Trials 12 (2011): 133.