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

Acute angle closure glaucoma remains a sight-threatening condition requiring immediate intervention. While prior research has established the urgency of lowering intraocular pressure, gaps remain in defining standardized protocols for emergency treatment. Existing literature highlights the variability in treatment approaches across institutions. This uncertainty drove the need for a formalized protocol to guide emergency care. No prior work had resolved the effectiveness of such a protocol in a real-world setting. The absence of a consistent framework limits reproducibility and patient outcomes. This study addresses the need for a structured approach to AACG management. It contributes by evaluating a specific protocol's impact on treatment efficiency and visual outcomes.

This study aimed to evaluate the effectiveness of a newly introduced AACG treatment protocol. The protocol was developed following a clinical audit to improve emergency care consistency. The goal was to determine if the protocol could achieve rapid intraocular pressure control. The researchers also sought to assess long-term visual and structural outcomes. The motivation stemmed from the high risk of permanent vision loss in untreated AACG. The study focused on a consecutive patient cohort to ensure real-world applicability. The protocol's impact on treatment duration and medication use was a key objective. The researchers intended to document both short-term and six-month follow-up outcomes.

A descriptive analysis was conducted on 63 consecutive AACG patients treated under the new protocol. Patient records were reviewed three and a half years after protocol implementation. The study measured intraocular pressure, visual acuity, and treatment duration. Data on medication use and need for surgical intervention were also collected. The researchers evaluated whether patients required osmotic diuretics for IOP control. Fellow eye development of AACG was monitored prior to peripheral iridotomy. Visual acuity outcomes were categorized using standard metrics. Six-month follow-up data on treatment independence and optic disc status were analyzed.

At presentation, the mean intraocular pressure was 56 mmHg in the affected eye. Sixty-eight percent of patients had a visual acuity of 6/60 or worse initially. The average time to achieve IOP control was 3 hours, with a range of 1 to 7 hours. Forty-four percent achieved control without osmotic diuretics. No fellow eyes developed AACG before peripheral iridotomy was performed. Forty-four percent required no further treatment after initial IOP control. Twenty-one percent needed additional topical treatment, while 35% required surgery. At six months, 67% of patients were treatment-free with 65% showing a normal optic disc.

The study demonstrates that the treatment protocol provided clear guidance for AACG management. Rapid intraocular pressure control was achieved in most cases following protocol use. The protocol reduced the need for osmotic diuretics in nearly half the patients. The absence of fellow eye AACG development supports protocol effectiveness. Visual acuity improved significantly in the majority of patients. Six-month outcomes showed a high rate of treatment independence. The optic disc returned to normal in over two-thirds of patients. These findings suggest the protocol is effective for emergency AACG treatment.