Surgical management of chronic angle-closure glaucoma

Abstract

Chronic angle-closure glaucoma (CACG) is a major cause of blindness, particularly in Asia. The goals of management are to prevent both progression of anatomic angle closure and progression of glaucomatous optic neuropathy, the latter by controlling intraocular pressure (IOP). Laser iridotomy to eliminate pupillary block is the definitive initial treatment and laser peripheral iridoplasty is the second-line treatment to eliminate any residual appositional angle closure. Topical medications are used if IOP remains uncontrolled. If the target pressure is not reached with maximally tolerated medications, operative surgery is indicated. Options include trabeculectomy with or without lens extraction, lens extraction alone, goniosynechialysis with or without lens extraction, cyclodestructive procedures and glaucoma implants. Recently, lens extraction has been actively studied and appears to be promising as an effective treatment, since it reverses the anatomical predisposition to angle closure. More work needs to be done to define its role in the management of CACG.

Keywords::

• angle-closure glaucoma
• cyclodestruction
• glaucoma implant
• goniosynechialysis
• phacoemulsification
• phacotrabeculectomy
• surgical iridectomy

Acknowledgement

Supported in part by the Norman and Sandra Pessin Research Fund of the New York Glaucoma Research Institute, NY, USA.