Primary angle-closure is the synechial or appositional closure of the anterior chamber angle secondary to multiple mechanisms resulting in raised intraocular pressure and structural changes in the eyes.
Iridotrabecular contact is the hallmark of primary angle-closure and the most commonly identified sign which indicates that treatment is required.
It is defined by at least 180 degrees of iridotrabecular contact together with an elevated intraocular pressure or peripheral anterior synechiae or btoh
Primary angle-closure glaucoma is the presence of glaucomatous optic neuropathy.
Following iridotomy, patients with a residual open angle or a combination of open angle and some peripheral anterior synechiae (PAS) with or without glaucomatous optic neuropathy should be followed at least yearly
Repeat gonioscopy to determine interval changes (eg increased extent of PAS, development of secondary angle-closure from cataract progression and increased lens thickness)
Subsequent follow-up intervals will depend on the clinical findings
Reassess visual function, risk factors [especially gonioscopic changes and intraocular pressure (IOP)], quality of life
Reassess structure and function of the optic nerve
Assess adherence to the treatment plan
Revise management plan, if necessary, and discuss follow-up plan
Indications for more frequent surveillance/follow-up:
Change in health status
IOP above target
Side effect to glaucoma medication
Visual field change
Intervening eye infection (especially for post-operative eyes), surgery, trauma, iritis
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