Management
Î Patients with PAC may have elevated IOP as a result of a chronic
compromise of aqueous outflow due to appositional or synechial angle
closure, or from damage to the trabecular meshwork after previous
intermittent AACC. Iridotomy is indicated for eyes with PAC or PACG.
(I++, G, S)
• This may be performed using either a thermal or neodymium yttrium-aluminum-
garnet (Nd:YAG) laser.
Î A growing body of evidence indicates that cataract extraction alone may
lead to substantial IOP lowering in some PACG patients and can be
considered as an option for treatment. (I+, G, D)
Î In AACC, medical therapy is usually initiated first to lower the IOP,
to reduce pain and to clear corneal edema. Iridotomy should then be
performed as soon as possible. (III, G, S)
Î Laser iridotomy is the preferred surgical treatment because it has a
favorable risk-benefit ratio. (II+, M, S)
Î When laser iridotomy is not possible or if the AACC cannot be medically
broken, LPI (even with a cloudy cornea), paracentesis, and incisional
iridectomy remain effective alternatives. (II+, M, D)
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