Role of sequential treatment of paracentesis followed by laser peripheral iridotomy in acute primary angle closure

Aim: To assess the role of sequential treatment of paracentesis followed by laser peripheral iridotomy in acute primary angle closure. Methods: This was a prospective interventional study of acute primary angle closure in Indonesian patients. All eyes underwent paracentesis immediately after admission to reduce the intraocular pressure, followed by laser peripheral iridotomy on the following day to relieve pupillary blockade. A comprehensive eye examination was performed. The criterion for success was intraocular pressure <21 mm Hg with or without glaucoma medication. Risk factors assessed were age, duration of acute symptoms, presenting intraocular pressure, intraocular pressure response to paracentesis and to laser peripheral iridotomy, anterior chamber depth, and extent of peripheral anterior synechiae. Results: Forty five eyes of 45 patients with acute primary angle closure were recruited, of whom 38 were women. The duration of symptoms ranged from 2 to 30 days (median, 14 days). The mean extent of peripheral anterior synechiae was 7.7 clock hours (SD, 3.1 clock hours) and the mean presenting intraocular pressure was 55.9 mm Hg (SD, 13.4 mm Hg; range, 30.0-78.0 mm Hg). After paracentesis, the mean intraocular pressure decreased to 27.0 (SD, 12.8 mm Hg; range, 15.0-54.0 mm Hg). After laser peripheral iridotomy, the mean intraocular pressure was 24.0 mm Hg (SD, 15.2 mm Hg; range 8.0-40.0 mm Hg). Success was achieved in 21 eyes and the variable risk factor influencing success was extent of peripheral anterior synechiae. Conclusion: The success rate for sequential treatment was 47% of affected eyes and was determined mostly by the extent of peripheral anterior synechiae.