Acute angle closure glaucoma: an evaluation of a protocol for acute treatment

Purpose To report the use of a protocol for the treatment of acute angle closure glaucoma (AACG) and document its effectiveness. Methods Following a clinical audit, a formal protocol for the treatment of AACG was introduced in our department. Three and a half years later, the records of 63 consecutive patients were reviewed. A descriptive analysis was performed. Results At presentation the mean intraocular pressure (IOP) in the affected eye was 56 mmHg. The visual acuity was 6/60 or worse in 68% of patients. The mean duration to achieve adequate IOP control was 3h (range 1-7 h) and 44% of the patients achieved this without the use of osmotic diuretics. None of the fellow eyes developed AACG prior to peripheral iridotomy. No further medical or surgical treatment was needed in 44%. Further topical treatment alone and surgical treatment were needed in 21% and 35% respectively. Following adequate IOP control, 76% had a visual acuity of 6/24 or better. All who had a final visual acuity of 6/60 or worse had significant non-glaucomatous pathology. At 6 months follow-up, 67% were treatment free and 65% had a normal optic disc. Conclusions This study demonstrates that this treatment protocol provided comprehensive and explicit guidance on the emergency treatment of AACG. This resulted in rapid IOP control following presentation and eventual favourable outcome in most cases.