Surgical management of chronic angle-closure glaucoma

Chronic angle-closure glaucoma is a major cause of blindness, particularly in Asia. The goals of management are to prevent both progression of anatomic angle-closure and progression of glaucomatous optic neuropathy, the latter by controlling intraocular pressure. Laser iridotomy to eliminate pupillary block is the definitive initial treatment and laser peripheral iridoplasty is the second-line treatment to eliminate any residual appositional angle-closure. Topical medications are used if the intraocular pressure remains uncontrolled. If the target pressure is not reached with maximally tolerated medications, surgery is indicated. Options include trabeculectomy with or without lens extraction, lens extraction alone, combined phacoemulsification and non-penetrating deep sclerectomy, goniosynechialysis with or without lens extraction, cyclodestructive procedures, and glaucoma drainage implants. Recently, lens extraction has been actively studied and appears to be promising as an effective treatment, since it reverses the anatomical predisposition to angle-closure. More work needs to be done to define its role in the management of chronic angle-closure