Primary angle‐closure glaucoma: an update

Abstract

ABSTRACT. Primary angle-closure glaucoma is potentially a devastating disease, responsible for half of glaucoma-related blindness worldwide. Angle closure is characterized by appositional approximation or contact between the iris and trabecular meshwork. It tends to develop in eyes with shallow anterior chambers, anteriorly positioned or pushed lenses, and angle crowding. Risk of primary angle-closure glaucoma is high among women, the elderly and the hyperopic, and it is most prevalent in Asia. Investigation into genetic mechanisms of glaucoma inheritance is underway. Diagnosis relies on gonioscopy and may be aided by anterior segment optical coherence tomography and ultrasound biomicroscopy. Treatment is designed to control intraocular pressure while monitoring changes to the angle and optic nerve head. Treatment typically begins with medical management through pressurereducing topical medications. Peripheral iridotomy is often performed to alleviate pupillary block, while laser iridoplasty has been found effective for mechanisms of closure other than pupillary block, such as plateau iris syndrome. Phacoemulsification, with or without goniosynechialysis, both in eyes with existing cataracts and in those with clear lenses, is thus far a viable treatment alternative. Long-term research currently underway will examine its efficacy in cases of angle closure in early stages of the disease. Endoscopic cyclophotocoagulation is another treatment option, which can be combined with cataract surgery. Trabeculectomy remains effective therapy for more advanced cases.

Medical Management of Glaucoma in the 21st Century from a Canadian Perspective

“…Primary angle closure glaucoma (PACG) occurs when access to the trabecular meshwork (TM) is physically obstructed, typically by the iris, and the drainage angle is closed [23]. Although a less common form of glaucoma, PACG is a major cause of blindness worldwide due to the severity of the disease, contributing to 50% of the world's blindness from glaucoma [24].…”

Differentiating Urgent and Emergent Causes of Acute Red Eye for the Emergency Physician

“…AACG is defined as closure (or narrowing) of the anterior chamber angle, causing elevated intraocular pressure and eventual optic nerve damage 5,27. Risk factors include increased age, female gender (three times more common), Asian ethnicity, shallow anterior chamber, hyperopia, and certain medications (topiramate or sulfa) 27.…”

“…Risk factors include increased age, female gender (three times more common), Asian ethnicity, shallow anterior chamber, hyperopia, and certain medications (topiramate or sulfa) 27. Patients typically present with headache, nausea, vomiting, halos around lights, photophobia, blurred vision, and pain.…”

Donor sclera versus bovine pericardium as patch graft material in glaucoma implant surgery and the impact of a drainage suture

“…2011; Wright et al. 2016). GDD surgery has been shown to have a lower failure rate than trabeculectomy with similar reduction in intraocular pressure, fewer early complications and less need for additional glaucoma surgery (Vass et al.…”