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primary%20angle-closure%20glaucoma
PRIMARY ANGLE-CLOSURE GLAUCOMA
Treatment Guideline Chart
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.

Primary%20angle-closure%20glaucoma Management

Follow Up

  • Following iridotomy, patients with a residual open angle or a combination of open angle and some 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 IOP], and 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
    • Disc change
    • VF change
    • Intervening eye infection (especially for post-operative eyes), surgery, trauma, iritis
  • If PACD diagnosis is in question or is refractory to treatment, patient should be referred to an ophthalmologist with special training or experience in managing this condition
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