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Glaucoma 2 primary angle closure glaucoma,dr.k.n.jha,02.11.16
- 1. Angle-Closure glaucoma Prof KN Jha,MS.
- 2. Learning Aim • Definitionof Angle-closure glaucoma • Primary angle-closure glaucoma (PACG) • Clinical features and treatment of PACG
- 3. Angle Closure glaucoma •Angle closure glaucoma are a large and diverse group of diseases characterized by peripheral anterior synechia and/ or iridotrabecular apposition. • Angle closure: apposition of peripheral iris to the trabecular meshwork and the resulting reduced drainage of the aqueous humor through anterior chamber angle.
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- 5. Angle Closure glaucoma •Primary angle closure glaucoma: there is no underlying pathologic cause , there is only anatomic predisposition. • Secondary angle closure glaucoma: underlying pathologic cause e.g. intumescent lens, iris neovascularisation initiates the angle closure.
- 6. Primary Angle Closureglaucoma( PACG) • Primary angle closure Suspect( PAC-Suspect) • Primary angle Closure (PAC) • Primary Angle-Closure Glaucoma(PACG)
- 7. Mechanism of angleclosure • Mechanism that push the iris forward • Mechanism that pull the iris forward
- 8. PRIMARY ANGLE CLOSUREGLAUCOMA (PACG)
- 9. Primary angle closureglaucoma ( PACG) • Primary angle closure is the leading cause of glaucoma worldwide. • Cause: relative pupillary block, plateau iris, anterior lens movement.
- 10. PACG : RiskFactors • Race: prevalence variable across races • Ocular biometrics: crowded anterior segment of the eye, short axial length, shallow anterior chamber ( < 2.5 mm) • Age above 40 years • Gender: M:F • Family history • Refraction
- 11. Anatomical predispositions Convex iris-lens diaphragm •Shallow anterior chamber • Narrow entrance to chamber angle
- 12. Acute PAC:Pathophysiology IOP risesrapidly due to sudden blockage of TM by iris. • Pupillary block: flow of aqueous through pupil is impeded ( relative pupillary block) • Pupillary block causes pressure gradient between posterior and the anterior chamber. • Due to pressure gradient the peripheral iris bows forward ( iris bombé )against the trabecular meshwork leading to obstruction of aqueous outflow and rise of IOP.
- 13. Pathogenesis : Pupillaryblock • Increase in physiological pupil block • Dilatation of pupil renders peripheral iris more flaccid • Increased pressure in posterior chamber causes iris bombe • Angle obstructed by peripheral iris and rise in IOP
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- 17. Acute angle closure Symptoms:Ocular pain, headache, blurred vision, halos , nausea , vomiting. Signs Conjunctival and circumcorneal congestion Cornea: hazy Anterior chamber: shallow Pupil: mid dilated, sluggish and irregular Mild aqueous flare and ant chamber cells Optic nerve head may be swollen IOP: high
- 18. Diagnosis History IOP ocular examination: CCC, cornealedema , shallow ant chamber, pupillary signs Gonioscopy : Peripheral anterior synechia Sector atrophy of iris Pigment dusting on iris surface and corneal endothelium Glaukomflecken: small ant subcapsular lens opacities
- 19. Treatment • Preventive: Screeningfor people at greatest risk for angle closure. • Definitive treatment: Iridectomy/ / laser iridoplasty/ pupilloplasty • Treatment of the acute angle closure
- 20. PACG : Treatmentof the acute attack • Pilocarpine eye drop 1-2% in the affected and the fellow eye • Topical beta-adrenergic blocker • Carbonic anhydrase inhibitor • Hyperosmotic agent: Mannitol 20% I.V., Oral glycerol • Globe compression
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- 23. PACG:Treatment of thefellow eye • PAC is a bilateral disease • There is 50-80 % chance of the fellow eye developing acute attack over next 5-10 years. • Peripheral Iridectomy
- 24. Follow up • Repeatgonioscopy to look for chronic angle closure.
- 25. PACG : Pointsto remember • Predisposing factors • Pathophysiology • Clinical features • Treatment • Prevention