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A. Sawada, A. Aoyama, T. Yamamoto; THE PROGNOSIS OF ACUTE PRIMARY ANGLE CLOSURE OR ACUTE PRIMARY ANGLE CLOSURE GLAUCOMA. . Invest. Ophthalmol. Vis. Sci. 2004;45(13):4475.
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Purpose: To investigate the clinical course of acute primary angle–closure (APAC) or acute angle–closure glaucoma (APACG) Methods: We retrospectively reviewed our records of 56 consecutive APAC or APACG eyes between March 1992 and November 2002, and examined their clinical course after the laser or surgical intervention. Immediately after the diagnosis, one drop of 2% pilocarpine was instilled 3 times per 5 minute. Additionally, mannitol and acetazolamide were intravenously administered. If possible systematically, one drop of beta–blocker was topically applied. Subsequently, laser iritotomy or surgical peripheral iridectomy and/ or laser iridoplasty was performed. If IOP control was poor under maximum tolerable ocular hypotensive agents, trabeculectomy with adjunctive mitomycin C (MMC) was undertaken. Results: At presentation, mean age was 68.3±9.1 (range: 50–88), and female was forty–six. Mean intraocular pressure (IOP) during the attack was 53.3±12.5 mmHg (range: 30 to over 80 mmHg). The extent of peripheral anterior synechiae (PAS), observed with the aid of pressure gonioscopic lens after the cessation of acute attack, varied between 0.0 and 12.0 hours. After laser therapy, success probability rate over 9 years, which defined as IOP less than 21 mmHg with or without medications, was 79.5±8.1 %. In ten eyes (10/56; 17.9%) trabeculectomized because of poor IOP control, the success probability rate over 7 years under the above criterion was only 33.3±27.2 %. Conclusions: Without the intervention of filtering surgery, 82.1% of eyes with APAC or APACG could keep good IOP control with anti–glaucoma drugs or no medications. However, APAC or APACG eyes, which trabeculectomized inevitably, predisposed to poor prognosis even with intraoperative application of MMC.
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