Interventions for angle-closure glaucoma: an evidence-based update.
OBJECTIVE
To assess the interventions to treat acute angle closure (AAC) and primary angle closure (PAC) with or without glaucomatous optic neuropathy.


CONCLUSIONS
Primary angle closure is one of the leading causes of blindness in East Asia. At present, there are few clinical guidelines on the optimal treatment of AAC or PAC in the affected or contralateral eye.


METHODS
All randomized clinical trials, prospective controlled clinical trials, nonprospective controlled clinical trials, and retrospective case series with >50 cases that evaluated treatments for AAC or PAC were included. Studies published in the English language were identified from MEDLINE, PubMed, EMBASE, and the Cochrane Collaborations, as well as by a hand search of the reference lists of important articles.


RESULTS
Nine randomized clinical trials and 24 nonrandomized clinical trials and large case series were evaluated. Laser peripheral iridotomy (LPI) has been found to be as effective as surgical peripheral iridectomy in randomized clinical trials of the affected and contralateral eyes of AAC or PAC patients with or without evidence of glaucoma. In another randomized clinical trial, latanoprost was found to decrease intraocular pressure (IOP) more than timolol for PAC in patients for whom LPI alone failed.


CONCLUSIONS
This review suggests that LPI should be recommended for the treatment of affected and contralateral eyes of AAC patients. In patients with PAC and insufficient treatment with LPI, latanoprost eye drops may decrease IOP more than timolol. There is still insufficient evidence about other interventions for the treatment of AAC and PAC.
Saw
Seang-Mei
SM
Department of Community, Occupational and Family Medicine, National University of Singapore, 16 Medical Drive, Singapore 117597, Republic of Singapore. cofsawsm@nus.edu.sg
Gazzard
Gus
G
Friedman
David S
DS
D000208:Acute Disease; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D015812:Glaucoma, Angle-Closure / Q000628:therapy*; D006801:Humans; D007429:Intraocular Pressure / Q000187:drug effects; D032801:Iridectomy / Q000379:methods; D000077338:Latanoprost; D011446:Prospective Studies; D011461:Prostaglandins F, Synthetic / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic
D000959:Antihypertensive Agents; D011461:Prostaglandins F, Synthetic; D000077338:Latanoprost