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Evidence-based management of primary angle closure glaucoma

Emanuel, Matthew E.; Parrish, Richard K. II; Gedde, Steven J.

Current Opinion in Ophthalmology: March 2014 - Volume 25 - Issue 2 - p 89–92
doi: 10.1097/ICU.0000000000000028
GLAUCOMA: Edited by Donald L. Budenz

Purpose of review To review the classification of primary angle closure (PAC) and discuss the evidence-based management of each type.

Recent findings There is limited evidence to support the prophylactic treatment of primary angle closure suspects. Cataract and clear lens extraction may be more effective than traditional therapy in controlling intraocular pressure (IOP) in patients with PAC, primary angle closure glaucoma, and acute angle closure crisis.

Summary Treatment of angle closure depends on the signs of chronic angle damage and glaucomatous optic neuropathy. In the absence of such evidence, serial gonioscopy may be the preferred therapy. If signs or symptoms are present, medical therapy and laser peripheral iridotomy are beneficial. However, recent data suggest that cataract extraction may be more effective at controlling the IOP than laser or incisional glaucoma procedures.

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

Correspondence to Matthew Emanuel, MD, Bascom Palmer Eye Institute, 900 Northwest 17th Street, Miami, FL 33136, USA. Tel: +1 305 326 6000; fax: +1 305 326 6478; e-mail:

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins