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Corneal indentation in the early management of acute angle closure.

Ophthalmology 2009 January
PURPOSE: To describe in detail corneal indentation (CI) in the management of a series of patients treated for acute angle closure (AAC).

DESIGN: Retrospective, consecutive, noncomparative case series.

PARTICIPANTS: Seven consecutive patients (8 eyes) referred to the authors with the diagnosis of AAC. Patients presented to the Prince of Wales Hospital, Randwick, or to the private practices of the authors.

INTERVENTION: Seven patients (8 eyes) underwent CI as part of their early management for AAC.

MAIN OUTCOME MEASURES: Reduction in intraocular pressure (IOP), symptoms of AAC and pain relief.

RESULTS: Of the 7 patients, complete data were available for 6. The IOP was significantly reduced (P<0.05) and 3 of 4 patients with severe acute pain reported early resolution of pain after CI. The average reduction in IOP was 20.9 mmHg (range +1 to -45). All patients subsequently underwent definitive management with laser peripheral iridotomies or lensectomy using phacoemulsification. Three patients treated acutely with CI without any medical agents had a mean IOP reduction of 21 mmHg (range, 20-23) after indentation.

CONCLUSIONS: Corneal indentation is a rapid, portable, and effective method of reducing elevated IOP in the setting of AAC. It can be performed with instrumentation that is readily at hand and allows for rapid pain relief. This reduction in IOP improves corneal clarity and permits further definitive management of the patient with AAC.

FINANCIAL DISCLOSURE(S): The authors have no proprietary or commercial interest in any materials discussed in this article.

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