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


RESULTS
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.


CONCLUSIONS
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.
Matthew E
ME
Emanuel
Richard K
RK
Parrish
Steven J
SJ
Gedde
D002387:Cataract Extraction; D019317:Evidence-Based Medicine; D015812:Glaucoma, Angle-Closure / Q000145:classification* / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D032801:Iridectomy; D007498:Iris / Q000601:surgery*; D053685:Laser Therapy; D007908:Lens, Crystalline / Q000601:surgery*; D014065:Tonometry, Ocular