An Overview of Angle-Closure Management

Abstract

© 2015, Elsevier Limited. All rights reserved. Primary angle-closure glaucoma is a leading cause of glaucoma blindness worldwide and remains a major public health problem. Although severe and highly destructive in nature, treating PAC is challenging and rewarding. It is possible to prevent and permanently cure the condition if an appropriate treatment is instituted early enough before irreversible changes in the trabecular meshwork and glaucomatous optic nerve damage have occurred. Since several pathological mechanisms may coexist in an eye, proper treatment depends on the accurate diagnosis of the specific pathogenesis. In addition to gonioscopy, ocular biometry and imaging with UBM and AS-OCT are becoming vital tools for assessing the angle. Laser iridotomy effectively eliminates pupillary block in PAC. Prophylactic laser iridotomy is routinely recommended for the fellow eye of monocular PAC but not for all PACS. Eyes with non-pupillary block mechanisms respond unfavorably to the laser treatment and can develop recurrent attacks or progressive PAS. Lens extraction is effective for both pupillary block and angle crowding. With the advancement of surgical techniques and instrumentation, early lens extraction with or without GSL is gaining more popularity. It is replacing trabeculectomy as the primary surgery for refractory acute PAC.