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Evidence-based management of primary angle closure glaucoma.

Matthew E Emanuel1, Richard K Parrish, Steven J Gedde

  • 1Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA.

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|January 28, 2014
PubMed
Summary

Primary angle closure (PAC) management varies. While laser peripheral iridotomy is beneficial for symptomatic cases, cataract extraction shows promise for controlling intraocular pressure (IOP) in PAC and related conditions.

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Area of Science:

  • Ophthalmology
  • Glaucoma Research

Background:

  • Primary angle closure (PAC) is a significant cause of vision loss.
  • Accurate classification is crucial for effective management.

Purpose of the Study:

  • To review the classification of primary angle closure (PAC).
  • To discuss the evidence-based management strategies for each PAC type.

Main Methods:

  • Literature review of existing studies on PAC classification and treatment.
  • Analysis of evidence supporting various management options.

Main Results:

  • Limited evidence supports prophylactic treatment for primary angle closure suspects.
  • Cataract and clear lens extraction may be more effective for intraocular pressure (IOP) control in PAC, primary angle closure glaucoma, and acute angle closure crisis compared to traditional therapies.

Conclusions:

  • Treatment for angle closure is guided by signs of chronic angle damage and glaucomatous optic neuropathy.
  • Serial gonioscopy may be preferred in the absence of such damage.
  • Medical therapy and laser peripheral iridotomy are beneficial if signs or symptoms are present.
  • Emerging data suggest cataract extraction may be superior to laser or incisional glaucoma procedures for IOP control.