Acute Angle Closure: Revisiting Early Management

1. Ashish Agar^1,2
2. Katherine Masselos^1,2
3. David Wechsler^3,4
4. Jed Lusthaus⁵
5. Ian Francis^1,2
6. Allan Bank^1,2

¹Prince of Wales Hospital, Sydney, Australia
²Faculty of Medicine, University of New South Wales, Sydney, Australia
³Liverpool Hospital, Sydney, Australia
⁴Concord Hospital, Sydney, Australia
⁵Sydney Eye Hospital, Sydney, Australia

Purpose: Acute Angle Closure (AAC) is increasingly recognized as a major concern in the Asia Pacific. Its management is crucial to long-term success in preventing glaucoma, aiming to relieve pain, lower IOP and enable further definitive treatment. We have trialled a simplified approach to early management with potential application in our region.

Method: The management protocols for AAC in several hospitals and private clinics were reviewed to incorporate Corneal Indentation (CI) as an initial step, followed by conventional medical/laser/surgical techniques as appropriate. CI is performed according to our previously published method involving 3 cycles of 30 sec central or inferior indentation with glass rod or gonio lens.

Results: CI was found to be easily added to the protocols with minimal training or additional resources required. The procedure was well tolerated and when successful in breaking the AAC the effect was dramatic. It was felt to be effective in relieving pain and achieving IOP reduction in a significant proportion of presentations, thus reducing the burden of standard topical and oral agents. Laser iridotomy was also able to be performed sooner in many as the corneal view improved.

Conclusion: CI is a useful addition to early AAC management protocols, being a simple, cheap and safe technique. It reduces, and may perhaps avoid, the need for protracted pharmaceutical treatment and may potentiate laser treatment. Further studies would be helpful in quantifying these perceived benefits, as this simple technique could be especially useful in developing nations with little additional cost.