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

Follow Up

  • Following iridotomy, patients w/ a residual open angle or a combination of open angle & some peripheral anterior synechiae (PAS) w/ or w/o 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 & increased lens thickness) 
  • Subsequent follow-up intervals will depend on the clinical findings
  • Reassess visual function, risk factors [especially gonioscopic changes & intraocular pressure (IOP)], quality of life
  • Reassess structure & function of the optic nerve
  • Assess adherence to the treatment plan
  • Revise management plan, if necessary, & 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
    • Visual field change
    • Intervening eye infection (especially for post-operative eyes), surgery, trauma, iritis
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