Abstract
Acute primary angle closure requires emergency management that involves a rapid lowering of the intraocular pressure and resolution of relative pupil block – the most common mechanism of angle closure. Emergency strategies for lowering intraocular pressure include medical treatment and argon laser peripheral iridoplasty. Anterior chamber paracentesis and diode laser transcleral cyclophotocoagulation may be considered in special situations. Relative pupil block can be relieved by peripheral laser iridotomy and primary lens extraction; the latter is a more effective treatment according to the results of clinical trials. However, primary lens extraction can be technically demanding in the acute setting. Peripheral laser iridotomy has a role in relieving pupil block and should also be considered in most cases. Lens extraction may be combined with procedures such as goniosynechialysis, trabeculectomy or endoscopic cyclophotocoagulation. In this review, we aim to discuss the available evidence regarding the different treatment modalities. We also discuss the economic consideration, including cost-effectiveness and life expectancy, in the management of acute primary angle closure.
摘要
原发性急性闭角型青光眼大发作时需要紧急处理,包括快速降眼压和解除相对瞳孔阻滞,相对瞳孔阻滞是闭角型青光眼大发作最常见的发病机制。降低眼压的紧急治疗策略包括药物治疗和氩激光周边虹膜成形术。在特殊情况下,可以考虑前房穿刺术和半导体激光经巩膜睫状光凝术。通过周边激光虹膜切除术和晶体摘除术可以减轻相对瞳孔阻塞; 根据临床试验结果,晶体摘除术是更有效的治疗方法。然而,在急性情况下,晶体摘除在技术上要求很高。周边激光虹膜切除术具有减轻瞳孔阻滞作用,而且在大多数情况下也应当被考虑。晶体摘除术可以与手术相结合,如巩膜粘连松解、小梁切除术或内窥镜下睫状光凝术。在这此篇综述中,我们旨在讨论不同治疗方式的现有临床证据。我们进一步讨论了原发急性闭角型青光眼患者的经济因素,包括成本效益和预期寿命。
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Chan, P.P., Pang, J.C. & Tham, C.C. Acute primary angle closure–treatment strategies, evidences and economical considerations. Eye 33, 110–119 (2019). https://doi.org/10.1038/s41433-018-0278-x
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DOI: https://doi.org/10.1038/s41433-018-0278-x
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