Chan Poemen P, Zhang Xiulan, Aung Tin, Chew Paul T K, Congdon Nathan, Dada Tanuj, Fang Seng Kheong, He Mingguang, Kim Chan Yun, Lai Jimmy S M, Lee Jacky W Y, Liang Yuanbo, Lingam Vijaya, Liu Catherine Y, Rojanapongpun Prin, Sun Xinghuai, Tang Xin, Tham Clement C Y
Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China; Lam Kin Chung. Jet King-Shing Ho Glaucoma Treatment and Research Centre, The Chinese University of Hong Kong, Hong Kong SAR, China; Hong Kong Eye Hospital, Hong Kong SAR, China; Department of Ophthalmology and Visual Sciences, Prince of Wales Hospital, Hong Kong SAR, China.
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Disease, Guangzhou, China.
Asia Pac J Ophthalmol (Phila). 2025 Nov-Dec;14(6):100223. doi: 10.1016/j.apjo.2025.100223. Epub 2025 Jul 2.
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.
亚太青光眼协会（APGS）与亚太眼科教授学会（AAPPO）合作，召集了一个由来自10个国家/地区的18位国际专家组成的小组，以确定争议领域，并就急性原发性闭角型青光眼发作（APACA）的诊断和管理达成共识。APACA是一种相对常见且可能威胁视力的眼部急症，在中国和亚洲人群中尤为常见。通过及时、适当的干预，可以取得良好的效果。然而，按照目前的治疗方案，有两个方面需要改进：1）更快速、一致地降低眼压（IOP）；2）降低急性发作缓解并成功进行激光周边虹膜切开术后出现慢性眼压升高的患者比例。国际专家小组系统地重新审视并讨论了替代治疗方法，以解决上述问题。使用五点李克特量表（强烈同意、同意、中立、不同意、强烈不同意）评估共识，每位专家对每条共识声明进行匿名、独立的考虑和投票。当“同意”和“强烈同意”的票数总和达到75%的阈值时，即达成声明共识。氩激光周边虹膜成形术、前房穿刺术和激光瞳孔成形术被认为是快速降低眼压的合适选择。早期白内障超声乳化术对于预防APACA后进一步的视网膜神经节细胞丢失和疾病进展是有效的，并且在具备足够设施和专业知识的情况下值得考虑。有必要进行进一步研究，以评估角膜压陷作为一种快速、即时降低眼压治疗方法的安全性和有效性。
