Acute Angle Closure Attack Research Articles

Management of acute primary angle-closure glaucoma: a long-term follow-up of the results of peripheral iridectomy used as an initial procedure.

For the past 12 years peripheral iridectomy has been used as the initial surgical procedure after an acute attack of angle-closure glaucoma. The operation has been performed 2 to 5 days after the pressure has been controlled medically and has been followed routinely by prophylactic peripheral iridectomy in the fellow eye. Peripheral iridectomy for primary acute angle-closure glaucoma controlled the condition without any need for further medical or surgical therapy in 72% of cases. Careful and frequent follow-up within the first 4 postoperative months is essential to prevent further field loss, which can occur very rapidly if the pressure is not adequately controlled. If the pressure remains uncontrolled, further surgery should not be delayed. It was impossible to decide which patients would eventually need trabeculectomy when they first attended in the acute attack. Peripheral iridectomy as a prophylactic procedure was entirely effective in preventing an acute angle-closure attack in the fellow eye.

The effect of intraocular pressure on the pupil size.

The effect of an acute elevation of the intraocular pressure (IOP) on the pupil was investigated. It was shown that pupillary dilation occurred when the IOP exceeded diastolic blood pressure and that the dilation was a local phenomenon not due to changes in iris-angle architecture. The pressure necessary to dilate the pupil was shown to coincide with that pressure necessary to inhibit the filling of iris vessels with India ink injected into the arterial system. Systemically administered epinephrine reconstricted a pupil dilated by increased IOP subsequent to the systemic vasopressor response. It was concluded that the pupillary dilation noted in this study and probably that in acute angle-closure glaucoma attacks is secondary to pressure inhibition of blood flow to the iris sphincter muscle.