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PubMed · 15513461

Laser surgery for angle closure glaucoma.

Abstract

The angle closure glaucomas are defined by iridotrabecular contact, trabecular dysfunction, and elevated intraocular pressure (IOP). Laser iridotomy successfully eliminates the relative pupillary block component of the angle closure process, regardless of whether the underlying angle closure is related primarily to pupillary block or another mechanism. For those eyes with angle closure originating at an anatomic level posterior to the iris, such as plateau iris, lens-induced angle closure, or posterior segment processes, argon laser peripheral iridoplasty is often useful to further open the angle. The purpose of this article is to review the indications and techniques for laser iridotomy and laser iridoplasty in clinical practice.

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BibTeXRIS

Jeffrey M Liebmann, Robert Ritch. 2002. Laser surgery for angle closure glaucoma.. https://doi.org/10.1076/soph.17.2.84.14720

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[What should be done when laser iridotomy does not physically eliminate angle closure?].

Pupillary block is probably the underlying mechanism in most cases of angle closure. Laser iridotomy is the technique of choice for managing primary angle closure due to pupillary block. In some cases laser iridotomy does not physically eliminate appositional angle closure because mechanisms other than pupillary block are present. In other cases the mechanism of angle closure is not intermittent (appositional) but permanent (synechial). Iridoplasty is a simple and effective means of opening an appositionally closed angle. Lens extraction is often sufficient and advisable when cataract is present, followed if necessary by goniosynechialysis. Trabeculectomy can always be done later and more safely (30%). However, malignant glaucoma (ciliary block) may complicate trabeculectomy in cases with primary angle closure.

Glaucoma, Angle-Closure↗