This article is more than 5 years old. Information may no longer be current.
Surgical approach to primary angle-closure glaucoma differs among individual cases
Click Here to Manage Email Alerts
BEIJING — The timing of surgery in primary angle-closure glaucoma cases depends on factors including IOP, peripheral anterior synechiae, coexisting cataract and visual prognosis, Clement C.Y. Tham, MD, said here.
Speaking at the 25th APAO Congress about the appropriate time to perform surgery in primary angle-closure glaucoma cases, Dr. Tham said that physicians must first eliminate appositional closure. That can be addressed by laser iridotomy, iridoplasty or lens extraction, followed by medical therapy.
"If the pressure control is adequate, then everyone is happy. If the pressure control is inadequate, then depending on the particular situation, you may consider either goniosynechialysis with or without lens extraction ... or, alternatively, we may consider removing the lens and/or trabeculectomy," Dr. Tham said.
Goniosynechialysis is most effective in cases with extensive peripheral anterior synechiae and limited glaucomatous damage, Dr. Tham said.
He said if surgical procedures fail because IOP is uncontrolled, glaucoma implants can be used in patients with a good visual prognosis. Cyclodestructive procedures, including laser, can be used in cases with a poor visual prognosis.
He also outlined results of combined cataract and glaucoma surgery or cataract surgery-alone for coexisting cases of cataract and primary angle-closure glaucoma.