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Glaucoma, Angle Closure, Acute Treatment & Management

  • Author: Robert J Noecker, MD, MBA; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Nov 25, 2015
 

Medical Care

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.[14]

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Surgical Care

Laser iridotomy

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 gonioplasty

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.

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Contributor Information and Disclosures
Author

Robert J Noecker, MD, MBA Associate Professor, Department of Ophthalmology, University of Pittsburgh School of Medicine; Director, Glaucoma Service, Vice Chair, Department of Ophthalmology, University of Pittsburgh Medical Center Eye Center

Robert J Noecker, MD, MBA is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society, American Medical Association, American Society of Cataract and Refractive Surgery

Disclosure: Received consulting fee from Allergan for consulting; Received grant/research funds from Allergan, Zeiss, Lumenis for other; Received honoraria from Allergan, Alcon, Lumenis, Endo-optics for speaking and teaching.

Coauthor(s)

Malik Y Kahook, MD Clinical Instructor of Ophthalmology, Fellow in Glaucoma, Department of Ophthalmology, University of Pittsburgh Medical Center

Malik Y Kahook, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Cataract and Refractive Surgery, Association for Research in Vision and Ophthalmology, Colorado Medical Society

Disclosure: Received consulting fee from Alcon for consulting.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Martin B Wax, MD Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Research and Development, Head, Ophthalmology Discovery Research and Preclinical Sciences, Alcon Laboratories, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, Society for Neuroscience

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Kilbourn Gordon, III, MD, FACEP Urgent Care Physician

Kilbourn Gordon, III, MD, FACEP is a member of the following medical societies: American Academy of Ophthalmology, Wilderness Medical Society

Disclosure: Nothing to disclose.

References
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  2. Cantor L, et al. Glaucoma. Basic and Clinical Science Course. Section 10. 1996-7.

  3. Epstein DL, Allingham RR, Schuman JS. Chandler and Grant's Glaucoma. 4th ed. 1997.

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  11. 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].

  12. 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].

  13. 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].

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  15. 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].

  16. 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].

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