Sector iridectomy in the management of prolonged attacks of acute congestive glaucoma

Clinicians still encounter patients suffering from prolonged episodes of primary angle-closure glaucoma. These patients often have been misdiagnosed or neglected initially. While laser iridotomies have proven most effective in the treatment of acute angle-closure glaucoma, there is a diversity of opinion regarding the treatment of chronic forms, in particular when the congestive phase has been of long duration (e.g., 3 to 14 days). The fact that ophthalmologists must still contend with the dreaded complication of malignant glaucoma attests to the difficulty of treating this condition. A series of cases have been collected during the past 15 years, all having prolonged episodes of primary angle-closure glaucoma, where the anterior-chamber angles could not be opened medically before surgery. We found that laser iridotomy is not efficacious in this situation, and indeed often impossible to perform due to corneal edema. Our patients were treated surgically with sector iridectomies, with an extremely high degree of success, and a minimal complication rate. The results are presented in tabular form. The mechanism of action is described, and the reasons for the success of this procedure explained.