New concepts of Angle Closure Glaucoma 인천성모병원 이 나 영

Angle closure glaucoma Characterized by apposition of the peripheral iris against the trabecular meshwork, resulting in obstruction of aqueous outflow Primary vs Secondary angle closure glaucoma :the distinction has become increasingly artificial, the concept should probably be abandoned. Ex) Plateau iris

Angle closure glaucoma Primary open angle glaucoma (POAG) : more common Primary angle closure glaucoma (PACG) : more severe (if not properly treated->irreversible blindness) Namil study : 0.65% Japan : 0.41%, China : 1.5%, Black : 0.5% Caucasian : 0.1%, Eskimo : 2~3%

Current standard care Stepped approach :Surgery (laser or incisional) 와 medical managem ent 의 combination If these first line treatments fail ->Glaucoma surgery (e.g., trabeculectomy) indicat ed. PACG에서는 Glaucoma surgery로 안압조절이 실패 하면 다른녹내장에 비해 complication이 빈발한다. (Ex. flat anterior chamber and malignant glaucoma)

Phacoemulsification in PACG Lens : plays a major role in the mechanisms leading to PACG (pupillary block and angle crowding) A new approach to the management of PACG -> Lens extraction by phacoemulsification Debate : cataract이 없는 경우에도 ?, Op timing ??

Phacoemulsification in PACG Some studies have shown a substantial reduction of mean IOP in PACG after cataract extraction and IOL implantation. However, the surgical outcome regarding IOP control is unsatisfactory -> require subsequent filtering surgery. There was not enough evidence to assess the sup eriority of lens extraction over other intervention s to control IOP in this condition, and RCTs comp aring lens extraction with alternative treatment o ptions were required.

KJO

Thank for your attention.