Controversies, consensuses, and guidelines for acute primary angle closure attack (APACA) by the Asia-Pacific Glaucoma Society (APGS) and the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO)

Abstract

The Asia-Pacific Glaucoma Society (APGS), in collaboration with the Academy of Asia-Pacific Professors of Ophthalmology (AAPPO), convened a panel of 18 international experts from 10 countries/territories to identify areas of controversy and establish consensus on diagnosing and managing Acute Primary Angle Closure Attack (APACA). APACA is a relatively common and potentially vision-threatening ocular emergency, particularly in Chinese and Asian populations. With timely and appropriate intervention, favorable outcomes could be achieved. However, with the current treatment protocol, two areas need to be improved: 1) more rapid and consistent reduction of intraocular pressure (IOP), and 2) reducing the proportion of patients who develop chronic IOP elevation after resolution of an acute attack and successful laser peripheral iridotomy. The international panel of experts systematically revisited and debated alternative treatments to address the above issues. Consensus was evaluated using a five-point Likert scale (strongly agree, agree, neutral, disagree, and strongly disagree), in which each expert considered and voted anonymously and independently on each consensus statement. A statement consensus is established when the summation of votes for "agree" and "strongly agree" reaches a 75 % threshold. Argon laser peripheral iridoplasty, anterior chamber paracentesis, and laser pupilloplasty are considered appropriate and suitable options for rapid IOP reduction. Earlier phacoemulsification is effective in preventing further retinal ganglion cell loss and disease progression after APACA and is worth considering, provided adequate facilities and expertise are available. Further studies are warranted to evaluate the safety and efficacy of corneal indentation as a rapid and immediate treatment to lower IOP.