Management of Primary Angle-Closure Glaucoma

Lai, Jimmy FRCSEd, FRCOphth, FRCS (Glasgow), MMed, MD; Choy, Bonnie N. K. FCOphth
(HK); Shum, Jennifer W. H. FCOphth (HK)
Asia-Pacific Journal of Ophthalmology: January/February 2016 - Volume 5 - Issue 1 - p 5962

Abstract:

Primary angle-closure glaucoma (PACG) is a progressive optic nerve degeneration and is

defined as a glaucomatous optic neuropathy with associated characteristic enlargement of
optic disc cupping and visual field loss that is secondary to ocular hypertension caused by
closure of the drainage angle. Angle closure is caused by appositional approximation or
adhesion between the iris and the trabecular meshwork. The main treatment strategy for
PACG lies in the reduction of intraocular pressure, reopening of the closed angle, and
possible prevention of further angle closure. There is no universally agreed best surgical
treatment for PACG. Trabeculectomy, goniosynechialysis (GSL), glaucoma implant, and
cyclodestructive procedures are effective surgical options. Each of them plays an important
role in the management of PACG with its own pros and cons. Accumulating evidence is
available to show the effectiveness of visually significant and visually nonsignificant cataract
extraction in the treatment of PACG. Trabeculectomy and GSL are often combined with
cataract extraction, which may offer additional pressure control benefits to patients with
PACG. This review article will discuss laser peripheral iridotomy, argon laser peripheral
iridoplasty, and surgeries such as GSL, phacoemulsification, and phaco plus glaucoma
surgeries that lower intraocular pressure and also alter the anterior segment and/or
drainage angle anatomy. Currently, glaucoma implants and cyclodestruction are mainly
reserved for PACG patients who have failed previous filtering operations. Their role as initial
surgical treatment for PACG will not be discussed.

Key Words: surgery, primary angle-closure glaucoma.

Pseudophacomorphic Glaucoma Along with Pupillary Block after
VisianTM Implantable Collamer Lens Implantation for High Myopia
Abstract

Purpose: To report a case of bilateral glaucoma related to pseudophacomorphic mechanism

in one eye and pupillary block in the other eye after Visian Implantable Collamer Lens (ICL;
STAAR Surgical) insertion. Methods: A 44-year-old female with high myopia underwent
bilateral ICL implantation of MICL12.6 after sulcus diameter measurements were performed
by Pentacam. Results: Pseudophacomorphic glaucoma-related angle closure occurred due
to lens oversizing in the right eye. The mechanism was relieved via ICL explantation. In the
left eye, pupillary block developed in a subacute manner after closure of the Peripheral
Iridotomy (PI). The attack was ameliorated by reestablishing patency of the iridotomy.
Conclusions: ICL-related glaucomatous attacks may result from improper sizing as well as
from placement of a single PI. Identification of the proper mechanism is vital as treatments
differ significantly. In pseudo phacomorphic glaucoma, explantation is needed. In pupillary
block glaucoma, treatment involves establishment of a patent PI.

Keywords : Pseudophacomorphic, Glaucoma, Visian ICL, Pupillary Block

A review of drug-induced acute angle closure glaucoma for non-
ophthalmologists
Elliott Yann Ah-kee1, Eric Egong1, Ahad Shafi1 , Lik Thai Lim2 , James Li Yim3

Address for Correspondence:

lliott Yann Ah-kee 1 Monklands Hospital, Monkscourt Ave, Airdrie, North Lanarkshire, United
Kingdom 2 Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, United
Kingdom 3 Department of Ophthalmology, University Hospital Ayr, Ayr, Glasgow, United Kingdom
Email: elliottahkee@gmail.com

ABSTRACT Acute angle closure glaucoma is an ophthalmic emergency and can lead to
blindness if left untreated. Several types of drugs have the potential to precipitate acute
angle closure glaucoma. These include adrenergic, cholinergic and anticholinergic,
antidepressants, anticoagulants and sulfa-based agents. This article provides a basic
overview of the risk factors and pathophysiologic mechanisms involved in angle closure
glaucoma and focuses on drug-induced angle closure glaucoma for the non-
ophthalmologist. A PubMed search limited to the English language was conducted to find
relevant literature for the purpose of this article. Most attacks occur in subjects unaware
that they are at risk due to innately narrow iridocorneal angles. Clinicians should always
review medications in patients presenting with symptoms of acute angle closure glaucoma.
The aim of this article is to bring this ophthalmic condition to the attention of clinicians,
particularly those outside the field of ophthalmology who commonly prescribe these
medications or see these patients prior to referring to ophthalmologists.

Keywords: angle closure, glaucoma, drug-induced, iatrogenic