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Management algorithms for primary angle closure disease
Author(s) -
Thomas Ravi,
Walland Mark J
Publication year - 2013
Publication title -
clinical and experimental ophthalmology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.3
H-Index - 74
eISSN - 1442-9071
pISSN - 1442-6404
DOI - 10.1111/j.1442-9071.2012.02885.x
Subject(s) - medicine , open angle glaucoma , trabeculectomy , psychological intervention , cataract surgery , intervention (counseling) , glaucoma , ophthalmology , optometry , psychiatry
In contrast to primary open angle glaucoma, preventive interventions in primary angle closure disease ( PACD ) can sometimes be definitive. Data from randomized, controlled trials – and where this is not available – principles grounded in known biology, biological plausibility, logic, preferred practice and personal experience have been synthesized to develop explicit clinical algorithms for management of the spectrum of PACD . The mainstay of first‐line intervention is usually a laser iridotomy: a commonly necessary but sometimes insufficient manoeuvre in PACD . The crucial stepwise considerations after iridotomy are: whether the angle is open or closed; whether the IOP can be medically controlled; the extent of PAS , and the presence of visually significant cataract. Indication for subsequent interventions – which may include iridoplasty, cataract surgery, trabeculectomy or phacotrabeulectomy – are herein based on an arbitrary threshold (180 degrees) for angle opening and extent of PAS following initial treatment.