An evldence-based appraisal of interventions for acute angle closure glaucoma

Abstract

Objective To give an evidence-based appraisal to the interventions to treat acute angle closure glaucoma (AACG) in the affected or contralateral eye,and provide some suggestions to further clinical research.Methods Systematic review.Studies published in the English language were identified (1966 to December 2006) from MEDLINE,PubMed,EMBASE,and the Cochrane Collaborations,as well as studies published in the Chinese language from core journals of Chinese Periodical Fulltext Database (1979 to December 2006).Randomized clinical trials (RCTs),prospecfive controlled clinical trials,prospective noncontrolled clinical trials,and retrospective case series with>50 cases that evaluated treatments for AACG were included.The reference of existing reviews and included articles were hand-searched.The evidence qualifies were classified based on the levels of interventional evidence.Results Twenty-three articles in English and 5 articles in Chinese were eligible,including 8 randomized clinical trials (five in English,three in Chinese),and nonrandomized clinical trials and case series.The interventions include laser,surgical and medical therapies.Conclusions Laser peripheral iridoplasty as primary treatment to the acute attack of AACG showed a decrease of intraocular pressure (IOP) more rapidly than conventional medical treatment.Laserperipheral iridotomy (LPI) was an efficacious intervention to relieve pupillary block,control IOP,and prevent new attacks.LPI was found to be as effective as surgical peripheral iridectomy (SPI) in the IOP control of affected or contralateral eyes of AACG.There is still insufficient evidence and long-term follow-up reports about other interventions for the treatment of AACG. Key words: Glaucoma; Angle closure/treatment; Systematic review