1. New concepts of Angle Closure Glaucoma
인천성모병원
이 나 영

2. 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

3. 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%

4. 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)

5. 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 ??

6. 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.

11. KJO

15. Thank for your attention.