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Regarding ‘Management of Primary Angle-Closure Glaucoma’

Regarding ‘Management of Primary Angle-Closure Glaucoma’ Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/02/2020 LETTER TO THE EDITOR of PACG may not be as clear in some clin- phacotrabeculectomy. Asia Pac J Ophthalmol Regarding ‘Management of (Phila).2015;4:56–59. ical scenarios, such as those with angle- Primary Angle-Closure closure configuration and glaucomatous 3. Lai JS. The role of goniosynechialysis in the optic neuropathy but normal IOP as mea- Glaucoma’ management of chronic angle-closure glaucoma. sured during clinic hours. Perhaps future Asia Pac J Ophthalmol (Phila).2013;2:277–278. research involving 24-hour IOP monitoring may help differentiate among the follow- To the Editor: ing possible distinctions: (1) normal-tension Author‘sReply read with interest the article entitled glaucoma with subsequent age-related an- I “Management of Primary Angle-Closure gle narrowing, (2) intermittent angle clo- To the Editor: Glaucoma” (PACG). The article was a sure with glaucomatous optic neuropathy, e thank the reader for his interest thorough yet concise protocol for the man- or (3) PACG in evolution with high IOP W in our review aticle. For primary agement of PACG, organized in a manner occurring outside of clinic hours. angle-closure glaucoma (PACG), defined that is relevant to clinicians managing such In addition, as early cataract extraction as narrow angle with iridotrabecular con- cases. I am in agreement with the follow- becomes a more widely accepted treatment tact greater than 180/270 degrees and ing key messages conveyed by the authors: of PACG, research into the role of mini- glaucomatous optic neuropathy, usually (1) offer a peripheral laser iridotomy for all mally invasive ab interno surgeries may of- with visual field loss that is caused by PACG patients and argon laser peripheral fer new modalities to bypass the diseased raised intraocular pressure, the standard iridoplasty if plateau iris configuration is trabecular meshwork after mechanically treatment options were discussed in our present; (2) if early peripheral anterior reopening the angles with cataract extrac- review. For types of glaucoma not meet- synechiaes are present, goniosynechialysis tion and/or GSL. ing the definition of PACG, the surgical (GSL) combined with cataract extraction treatments described in our article may not may mechanically reopen the drainage an- apply. In PACG cases with persistent trabec- gle but for long-standing cases with trabec- ular dysfunction after open-angle surgical ular meshwork damage, the effect of GSL procedures, filtration surgeries for open- Jacky W.Y. Lee, FRCSEd may be limited; and (3) in such cases, a Dennis Lam & Partners Eye Center angle glaucoma can be considered. trabeculectomy may be required for pres- Hong Kong sure reduction. E-mail: jackywylee@gmail.com Over the years, researchers from Jimmy Lai, FRCS, MD Hong Kong and Singapore have contributed Department of Ophthalmology The author has no funding or conflicts of University of Hong Kong significantly to the literature on PACG, interest to declare. Hong Kong providing us with more evidence-based laism@hku.hk management. We have learned that cataract Bonnie N.K. Choy, FCOphth (HK) extraction lowers intraocular pressure (IOP), REFERENCES Jennifer W.H. Shum, FCOphth (HK) but having a higher IOP and using more Department of Ophthalmology antiglaucoma medications preoperatively 1. Lai J, Choy BN, Shum JW. Management of University of Hong Kong may hinder the IOP-lowering response of primary angle-closure glaucoma. Asia Pac J Hong Kong cataract extraction in PACG eyes. Ophthalmol (Phila).2016;5:59–62. Diagnostic tools have also been en- 2. Tham CC, Leung DY, Kwong YY, et al. Factors REFERENCES hanced from traditional gonioscopy and dark- correlating with failure to control intraocular room prone position test to 3-dimensional pressure in primary angle-closure glaucoma eyes 1. Lai J, Choy BN, Shum JW. Management of anterior segment optical coherence tomog- with coexisting cataract treated by primary angle-closure glaucoma. Asia Pac J raphy. Despite these technologies, the diagnosis phacoemulsification or combined Ophthalmol (Phila). 2016;5:59–62. Asia-Pacific Journal of Ophthalmology � Volume 5, Number 3, May 2016 www.apjo.org 223 Copyright © 2016 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/02/2020 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png The Asia-Pacific Journal of Ophthalmology Wolters Kluwer Health

Regarding ‘Management of Primary Angle-Closure Glaucoma’

The Asia-Pacific Journal of Ophthalmology , Volume 5 (3): 223 – May 1, 2016

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Publisher
Wolters Kluwer Health
Copyright
Copyright © 2016 by Asia Pacific Academy of Ophthalmology
Subject
Letter to the Editor
ISSN
2162-0989
eISSN
2475-5028
DOI
10.1097/APO.0000000000000206
pmid
27183292
Publisher site
See Article on Publisher Site

Abstract

Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/02/2020 LETTER TO THE EDITOR of PACG may not be as clear in some clin- phacotrabeculectomy. Asia Pac J Ophthalmol Regarding ‘Management of (Phila).2015;4:56–59. ical scenarios, such as those with angle- Primary Angle-Closure closure configuration and glaucomatous 3. Lai JS. The role of goniosynechialysis in the optic neuropathy but normal IOP as mea- Glaucoma’ management of chronic angle-closure glaucoma. sured during clinic hours. Perhaps future Asia Pac J Ophthalmol (Phila).2013;2:277–278. research involving 24-hour IOP monitoring may help differentiate among the follow- To the Editor: ing possible distinctions: (1) normal-tension Author‘sReply read with interest the article entitled glaucoma with subsequent age-related an- I “Management of Primary Angle-Closure gle narrowing, (2) intermittent angle clo- To the Editor: Glaucoma” (PACG). The article was a sure with glaucomatous optic neuropathy, e thank the reader for his interest thorough yet concise protocol for the man- or (3) PACG in evolution with high IOP W in our review aticle. For primary agement of PACG, organized in a manner occurring outside of clinic hours. angle-closure glaucoma (PACG), defined that is relevant to clinicians managing such In addition, as early cataract extraction as narrow angle with iridotrabecular con- cases. I am in agreement with the follow- becomes a more widely accepted treatment tact greater than 180/270 degrees and ing key messages conveyed by the authors: of PACG, research into the role of mini- glaucomatous optic neuropathy, usually (1) offer a peripheral laser iridotomy for all mally invasive ab interno surgeries may of- with visual field loss that is caused by PACG patients and argon laser peripheral fer new modalities to bypass the diseased raised intraocular pressure, the standard iridoplasty if plateau iris configuration is trabecular meshwork after mechanically treatment options were discussed in our present; (2) if early peripheral anterior reopening the angles with cataract extrac- review. For types of glaucoma not meet- synechiaes are present, goniosynechialysis tion and/or GSL. ing the definition of PACG, the surgical (GSL) combined with cataract extraction treatments described in our article may not may mechanically reopen the drainage an- apply. In PACG cases with persistent trabec- gle but for long-standing cases with trabec- ular dysfunction after open-angle surgical ular meshwork damage, the effect of GSL procedures, filtration surgeries for open- Jacky W.Y. Lee, FRCSEd may be limited; and (3) in such cases, a Dennis Lam & Partners Eye Center angle glaucoma can be considered. trabeculectomy may be required for pres- Hong Kong sure reduction. E-mail: jackywylee@gmail.com Over the years, researchers from Jimmy Lai, FRCS, MD Hong Kong and Singapore have contributed Department of Ophthalmology The author has no funding or conflicts of University of Hong Kong significantly to the literature on PACG, interest to declare. Hong Kong providing us with more evidence-based laism@hku.hk management. We have learned that cataract Bonnie N.K. Choy, FCOphth (HK) extraction lowers intraocular pressure (IOP), REFERENCES Jennifer W.H. Shum, FCOphth (HK) but having a higher IOP and using more Department of Ophthalmology antiglaucoma medications preoperatively 1. Lai J, Choy BN, Shum JW. Management of University of Hong Kong may hinder the IOP-lowering response of primary angle-closure glaucoma. Asia Pac J Hong Kong cataract extraction in PACG eyes. Ophthalmol (Phila).2016;5:59–62. Diagnostic tools have also been en- 2. Tham CC, Leung DY, Kwong YY, et al. Factors REFERENCES hanced from traditional gonioscopy and dark- correlating with failure to control intraocular room prone position test to 3-dimensional pressure in primary angle-closure glaucoma eyes 1. Lai J, Choy BN, Shum JW. Management of anterior segment optical coherence tomog- with coexisting cataract treated by primary angle-closure glaucoma. Asia Pac J raphy. Despite these technologies, the diagnosis phacoemulsification or combined Ophthalmol (Phila). 2016;5:59–62. Asia-Pacific Journal of Ophthalmology � Volume 5, Number 3, May 2016 www.apjo.org 223 Copyright © 2016 Asia Pacific Academy of Ophthalmology. Unauthorized reproduction of this article is prohibited. Downloaded from http://journals.lww.com/apjoo by BhDMf5ePHKbH4TTImqenVA5KvPVPZ0P5BEgU+IUTEfzO/GUWifn2IfwcEVVH9SSn on 06/02/2020

Journal

The Asia-Pacific Journal of OphthalmologyWolters Kluwer Health

Published: May 1, 2016

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