Conventional and emerging treatments in the management of acute primary angle closure

Pui Yi Boey¹, Shweta Singhal¹, Shamira A Perera¹, Tin Aung<sup>1,2

1</sup>Singapore Eye Research Institute, Singapore National Eye Centre, ²Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore

Abstract: The management of acute primary angle closure is directed at lowering the intraocular pressure and relieving pupil block. Conventional treatment involves the use of medical treatment and laser peripheral iridotomy, respectively, as a means for achieving these aims. Newer therapeutic strategies have been described that are potentially useful adjuncts or alternatives to conventional treatment. Emerging strategies that lower intraocular pressure include anterior chamber paracentesis, as well as laser procedures such as iridoplasty and pupilloplasty. A possible alternative to relieving pupil block is lens extraction, and may be combined with adjunctive measures such as goniosynechiolysis and viscogoniosynechiolysis. Trabeculectomy has a limited role in the acute setting. This review paper reviews the current evidence regarding conventional and newer treatment modalities for acute primary angle closure.

Keywords: intraocular pressure, pupil block, anterior chamber paracentesis, iridoplasty, pupilloplasty, goniosynechiolysis, viscogoniosynechiolysis, trabeculectomy