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Laser peripheral iridotomy viable treatment option for patients with PACG
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HONG KONG — Laser peripheral iridotomy is an effective treatment for patients with primary angle-closure glaucoma and can be considered a primary procedure for the disease, a physician said.
Tin Aung, PhD, FRCS(Ed), FRCOphth, said at the World Ophthalmology Congress here that while laser peripheral iridotomy requires close monitoring in follow-up for possible progression or increased IOP, and then further treatment if indicated, it appears to be an effective surgical option to lower IOP in primary angle-closure glaucoma (PACG) patients.
 Tin Aung |
"Laser peripheral iridotomy is recommended first therapy for primary angle-closure glaucoma," Dr. Aung said.
He cited a consensus reached by the World Glaucoma Association (WGA) regarding laser peripheral iridotomy and other surgical options for patients with PACG. Dr. Aung was a co-chair of the WGA consensus meeting.
The WGA found that laser peripheral iridotomy is a prophylaxis against acute angle closure and can be performed on an outpatient basis, Dr. Aung said.
"This outpatient basis will allow time to undertake elective surgery in those with uncontrolled IOP, those with advanced disease or with co-existing cataract," he said.
In addition to iridotomy, new medical treatments are also viable options for the treatment of patients with PACG, significantly reducing IOP, Dr. Aung said. However, compliance issues still remain with drugs.
Other surgical options for PACG include trabeculectomy, combined surgery, glaucoma implants, goniosynechialysis and cyclodestructive procedures, Dr. Aung said.
He said the aim of all treatment for patients with PACG, whether surgical or medical, is to prevent optic nerve damage, visual field loss and progressive angle closure. The indications for surgery, he said, include IOP not reaching the target pressure, lack of patient adherence to the medication regimen, co-existing cataract and possible progression of synechia closure.
More prospective studies are needed to determine long-term safety and efficacy of other surgical management treatments for patients with PACG. Extended studies on lens extraction and goniosynechialysis are especially needed to explore their viability as treatment options, Dr. Aung said.