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Anterior chamber paracentesis combined with laser peripheral iridotomy in treatment of medically uncontrollable acute primary angle-closure glaucoma

Background: To evaluate the efficacy of combined therapy of anterior chamber paracentesis (ACP) and laser peripheral iridotomy (LPI) in the treatment of medically uncontrollable acute primary angleclosure glaucoma (PACG).

Methods: It was performed by retrospectively analyzing 42 eyes of 42 patients with acute PACG. The patients were divided into two groups by the time length from symptom onset to hospital visit: 21 eyes of 21 patients in Group A were treated within 24 h, whereas 21 eyes of 21 patients in Group B were treated after 24 h. The acute PACG eye of each patient firstly received local as well as systemic medications to lower intraocular pressure (IOP), and subsequently combined ACP and LPI treatment, resulting from IOP levels of 35 mmHg or more for 2 h after medication.

Results: The IOPs of acute PACG eyes in Group A were significantly lower than those in Group B, and IOPs decreased substantially after the treatment in both Groups A and B. These differences were statistically significant (both P<0.05). Eighteen patients in Group A (85.7%) presented with anterior chamber angle above 180° after treatment, significantly higher compared with 7 (33.3%) in Group B (P<0.05). Three eyes (14.3%) treated with glaucoma surgery (trabeculectomy or glaucoma cataract combined with intraocular implementation) in Group A, and 14 (66.7%) in Group B.

Conclusion: Combined treatment of ACP and LPI can considerably decrease IOP in patients with medically uncontrollable acute PACG.

Author(s): Yuehua Li, Xin Qi, Shuo Yang, Xiaofeng Hu, Bangli Xu, Chunmei Cui, Wei Wang, Wen Hua