Treat PACG

Question 1

Goals to treat PACG

Answer 1

1. preserve visual func - control elevation in IOP
2. prevent damage to optic nerve
3. manage/prevent acute attack angle closure

Question 2

What does acute angel-closure crisis require?

Answer 2

1. medical emergency

2. urgent laser + surgical intervention

Question 3

What is treatment of choice for PACG

Answer 3

• peripheral laser iridotomy
• uses laser energy to cut hole –> iris to alleviate aq humour build up behind iris = reversal of appositional angle closure

Question 4

what therapy must acute angle closure receive?

Answer 4

• medical therapy
• lower Iop
• Reduce pain
• reverse corneal oedema before irridootmy

Question 5

How should IOP be lowered?

Answer 5

1. topical B-blockers
2. topical alpha-agonist
3. prostaglandin F2alpha analog
4. systemic carbonic anhydrase inhibtor
5. hyperosmotic agent

Question 6

Once the IOP has been controlled what med can be used?

Answer 6

• miotic - Pilocarpine

- breaks pupillary block

Question 7

What agent is used until laser iridotomy can be performed?

Answer 7

• topical IOP lowering agent

Question 8

What may break the pupillary block?

Answer 8

• cotton- tipped applicator

- gonioscopic lens

Question 9

If laser iridotomy cant be performed what is than performed?

Answer 9

• surgical incisional iridectomy - surgical removal of small portion peripherl iris to allow flow aq humour trapped in posterior chamber to migrate to anterior chamber - bypass normal flow pattern through pupil

Question 10

Can a topical corticosterioid be employed ?

Answer 10

• Yes to decrease inflammation

Question 11

What is lens extraction surgery ?

Answer 11

• another treatment modality

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Question 12

If a patient has PACG superimposed on preexisting POAG / synechia formaton causes reduce outflow with continued increase in IOP

Answer 12

• require chronic medical therapy