Paracentesis for angle closure glaucoma

Abstract

I found the report by Lam et al troubling (Ophthalmology 2002;109:64–70). The use of paracentesis for acute angle closure clearly results in rapid reduction of intraocular pressure, which may result in the entity known as decompression retinopathy, in which scattered deep retinal hemorrhages have been noted. These have been seen after trabeculectomy1Fechtner R.D. Minckler D. Weinreb R.N. et al.Complications of glaucoma surgery. Ocular decompression retinopathy.Arch Ophthalmol. 1992; 110: 965-968Crossref PubMed Scopus (64) Google Scholar, 2Dudley D.F. Leen M.M. Kinyoun J.L. Mills R.P. Retinal hemorrhages associated with ocular decompression after glaucoma surgery.Ophthalmic Surg Lasers. 1996; 27: 147-150PubMed Google Scholar or after laser peripheral iridotomy for acute angle closure glaucoma when medical treatment (without use of osmotic agents) was unable to break the initial attack.3Nah G. Aung T. Yip C.C. Ocular decompression retinopathy after resolution of acute angle closure glaucoma.Clin Exp Ophthalmol. 2000; 28: 319-320Crossref PubMed Scopus (16) Google Scholar, 4Waheeb S.A. Birt C.M. Dixon W.S. Decompression retinopathy following YAG laser iridotomy.Can J Ophthalmol. 2001; 36: 278-280PubMed Scopus (14) Google Scholar In some cases of decompression retinopathy, long-term loss of visual acuity has been described.2Dudley D.F. Leen M.M. Kinyoun J.L. Mills R.P. Retinal hemorrhages associated with ocular decompression after glaucoma surgery.Ophthalmic Surg Lasers. 1996; 27: 147-150PubMed Google Scholar To my knowledge, no cases have been described after medical management of elevated intraocular pressure in which osmotic agents were used. Were the patients enrolled in the study of Lam et al monitored for such retinopathy? If not, I would advise against using this method of management of acute angle closure, until its safety could be more completely evaluated in comparison with standard medical treatment (including osmotic agents) followed by laser peripheral iridotomy. I found the report by Lam et al troubling (Ophthalmology 2002;109:64–70). The use of paracentesis for acute angle closure clearly results in rapid reduction of intraocular pressure, which may result in the entity known as decompression retinopathy, in which scattered deep retinal hemorrhages have been noted. These have been seen after trabeculectomy1Fechtner R.D. Minckler D. Weinreb R.N. et al.Complications of glaucoma surgery. Ocular decompression retinopathy.Arch Ophthalmol. 1992; 110: 965-968Crossref PubMed Scopus (64) Google Scholar, 2Dudley D.F. Leen M.M. Kinyoun J.L. Mills R.P. Retinal hemorrhages associated with ocular decompression after glaucoma surgery.Ophthalmic Surg Lasers. 1996; 27: 147-150PubMed Google Scholar or after laser peripheral iridotomy for acute angle closure glaucoma when medical treatment (without use of osmotic agents) was unable to break the initial attack.3Nah G. Aung T. Yip C.C. Ocular decompression retinopathy after resolution of acute angle closure glaucoma.Clin Exp Ophthalmol. 2000; 28: 319-320Crossref PubMed Scopus (16) Google Scholar, 4Waheeb S.A. Birt C.M. Dixon W.S. Decompression retinopathy following YAG laser iridotomy.Can J Ophthalmol. 2001; 36: 278-280PubMed Scopus (14) Google Scholar In some cases of decompression retinopathy, long-term loss of visual acuity has been described.2Dudley D.F. Leen M.M. Kinyoun J.L. Mills R.P. Retinal hemorrhages associated with ocular decompression after glaucoma surgery.Ophthalmic Surg Lasers. 1996; 27: 147-150PubMed Google Scholar To my knowledge, no cases have been described after medical management of elevated intraocular pressure in which osmotic agents were used. Were the patients enrolled in the study of Lam et al monitored for such retinopathy? If not, I would advise against using this method of management of acute angle closure, until its safety could be more completely evaluated in comparison with standard medical treatment (including osmotic agents) followed by laser peripheral iridotomy.