Effect of anterior chamber paracentesis on initial treatment of acute angle closure

Abstract

Objective: To compare anterior chamber paracentesis (ACP) with standard medical management of acute primary angle closure (APAC).

Design: Prospective study.

Participants: Patients with APAC and intraocular pressure (IOP) ≥ 50 mm Hg were enrolled.

Methods: Patients were randomized to receive ACP and medical treatment (group 1) or medical management alone (group 2).

Results: There were 26 patients (mean age 69.3 ± 10.4 years, 31 eyes) in group 1 and 28 patients (mean age 67.0 ± 9.7 years, 30 eyes) in group 2. The IOP in group 1 was significantly lower at 15 minutes, 30 minutes, and 1 hour after treatment (p < 0.05). At 1, 2, and 24 hours after treatment, visual acuity was significantly better in group 1 than in group 2. At each time point after treatment, the grade of corneal edema was not different between the groups. Pain score at 1 and 2 hours after treatment was significantly lower in group 1 than in group 2; however, no difference was noted at 24 hours after treatment. The mean follow-up period in group 1 was 16.1 ± 1.3 months and in group 2 was 15.6 ± 1.4 months (p = 0.803). At last follow-up, IOP, pupil size, number of eyes with nonreactive pupils, and centre endothelial cell counts were not different; however, visual acuity was significantly better in group 1 (0.43 ± 0.06 logMAR vs 0.74 ± 0.10 logMAR, p = 0.007).

Conclusions: Immediate ACP is a safe and effective for rapidly lowering IOP, and is associated with better visual acuity than medical treatment alone.