Glaucoma, Angle Closure, Acute Treatment & Management
- Author: Robert J Noecker, MD, MBA; Chief Editor: Hampton Roy, Sr, MD more...
Definitive treatment of ACG is laser iridotomy, or, if the iris cannot be accessed by laser, surgical iridectomy.[12, 13] Medical treatment is intended to prepare the patient for laser iridotomy. The cornea should be cleared with osmotic agents, the pupil should be constricted, and IOP should be lowered to prevent acute damage to the optic nerve.
Treatment of choice for pupillary-block ACG is laser iridotomy. Iridotomy with an argon or Nd:YAG laser creates an opening in the iris through which aqueous humor trapped in the posterior chamber can reach the anterior chamber and trabecular meshwork. As aqueous flows into the anterior chamber through the iris defect, pressure behind the iris falls, allowing the iris to recede toward its normal position. This procedure opens the anterior chamber angle and relieves the blockade of trabecular meshwork. If the cornea is extremely cloudy or the patient cannot cooperate, incisional peripheral iridectomy may be performed instead of a laser procedure.
Laser may be used to create stromal burns in the peripheral iris. As the iris contracts, the anterior chamber angle deepens. Use laser gonioplasty as treatment of ACG due to plateau iris and nanophthalmos, or use it as a temporary measure to open the angle until laser iridotomy can be performed.
Shields MB. Textbook of Glaucoma. 4th ed. 1998.
Cantor L, et al. Glaucoma. Basic and Clinical Science Course. Section 10. 1996-7.
Epstein DL, Allingham RR, Schuman JS. Chandler and Grant's Glaucoma. 4th ed. 1997.
Hitchings RA. Glaucoma: current thinking. Br J Hosp Med. 1996 Mar 20-Apr 2. 55(6):312-4. [Medline].
Wang BS, Narayanaswamy A, Amerasinghe N, Zheng C, He M, Chan YH, et al. Increased iris thickness and association with primary angle closure glaucoma. Br J Ophthalmol. 2011 Jan. 95(1):46-50. [Medline].
Tan SZ, Sampat K, Rasool S, Nolan D. Unilateral acute angle closure glaucoma. BMJ Case Rep. 2013 Feb 25. 2013:[Medline].
Xu L, Cao WF, Wang YX, Chen CX, Jonas JB. Anterior chamber depth and chamber angle and their associations with ocular and general parameters: the Beijing Eye Study. Am J Ophthalmol. 2008 May. 145(5):929-36. [Medline].
Ah-Kee EY, Egong E, Shafi A, Lim LT, Yim JL. A review of drug-induced acute angle closure glaucoma for non-ophthalmologists. Qatar Med J. 2015. 2015 (1):6. [Medline].
Czyz CN, Clark CM, Justice JD, Pokabla MJ, Weber PA. Delayed Topiramate-induced Bilateral Angle-Closure Glaucoma. J Glaucoma. 2013 Apr 29. [Medline].
Nolan W. Anterior segment imaging: ultrasound biomicroscopy and anterior segment optical coherence tomography. Curr Opin Ophthalmol. 2008 Mar. 19(2):115-21. [Medline].
Sihota R, Dada T, Gupta R, et al. Ultrasound biomicroscopy in the subtypes of primary angle closure glaucoma. J Glaucoma. 2005 Oct. 14(5):387-91. [Medline].
Marchini G, Chemello F, Berzaghi D, Zampieri A. New findings in the diagnosis and treatment of primary angle-closure glaucoma. Prog Brain Res. 2015. 221:191-212. [Medline].
Sng CC, Aquino MC, Liao J, Zheng C, Ang M, Chew PT. Anterior segment morphology after acute primary angle closure treatment: a randomised study comparing iridoplasty and medical therapy. Br J Ophthalmol. 2015 Aug 20. [Medline].
Liesegang TJ. Glaucoma: changing concepts and future directions. Mayo Clinic Proceedings. 1996. 71:689-694.
Lai JS, Tham CC, Chan JC. The clinical outcomes of cataract extraction by phacoemulsification in eyes with primary angle-closure glaucoma (PACG) and co-existing cataract: a prospective case series. J Glaucoma. 2006 Feb. 15(1):47-52. [Medline].
Yao J, Chen Y, Shao T, Ling Z, Wang W, Qian S. Bilateral Acute Angle Closure Glaucoma as a Presentation of Vogt-Koyanagi-Harada Syndrome in Four Chinese Patients: A Small Case Series. Ocul Immunol Inflamm. 2013 May 29. [Medline].