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S. Chai, G. Tan, S.-T. Hoh, R. Husain, F. Oen, S. Seah, T. Aung; Efficacy of Medical Therapy in the Initial Management of Acute Primary Angle Closure in Asians. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5104.
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Recent studies have advocated the use of laser iridoplasty or anterior chamber paracentesis in the initial management of patients with acute primary angle closure (APAC). The aim of this study was to ascertain the effectiveness of medical treatment consisting of topical and systemic intraocular pressure (IOP) lowering agents in the initial management of APAC in an Asian population.
This was an observational case series of consecutive patients presenting with APAC at a Singapore hospital over 2 years. Upon diagnosis, all subjects received intravenous acetazolomide followed by oral acetazolamide, topical timolol, pilocarpine and betamethasone or prednisolone acetate. Resolution of APAC was defined as IOP less than 21 mm Hg with no acute symptoms.
134 consecutive APAC subjects were studied. The majority of subjects were Chinese (96.3%), and female (80%) and the mean age was 63.7 + 9.6 years (Range 42 - 83 years). The mean presenting IOP was 58 + 12.7 mmHg and mean duration of symptoms was 2.8 days. With medical therapy, APAC attacks resolved within 3, 6, 12 and 24 hours in 28 (21.5%), 58 (44.6%), 99 (76.2%) and 116 (89.2%) subjects respectively. Following resolution of APAC, laser peripheral iridotomy was performed in 81.6% and 16.2% of subjects underwent cataract extraction. There was failure of resolution of APAC in only 3 subjects (2.2%), requiring glaucoma surgery.
Medical therapy resulted in resolution of APAC within 12 hours in 76.2% and within 24 hours in 89.2% of subjects.
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