Abstract: Primary angle-closure glaucoma (PACG) represents a significant cause of irreversible vision loss worldwide, characterized by obstruction of aqueous outflow due to anatomical predisposition to angle closure. This article provides a comprehensive review of PACG, exploring its underlying pathophysiology, clinical manifestations, diagnostic criteria, treatment modalities, and recent advancements. By delving into the complexities of PACG, ophthalmologists can refine their approach to patient care and improve outcomes in this sight-threatening condition.

Introduction: Primary angle-closure glaucoma poses diagnostic and therapeutic challenges in ophthalmology, requiring a multifaceted understanding of its pathogenesis, risk factors, and clinical presentation. Early detection and appropriate management are essential for preserving visual function and preventing irreversible vision loss in individuals with PACG.

Pathogenesis: The pathophysiology of PACG involves anatomical predisposition to angle closure, typically due to shallow anterior chamber depth, anteriorly positioned lens, and thickened peripheral iris. These anatomical factors predispose individuals to pupillary block, iris bombe, and subsequent obstruction of aqueous outflow, leading to elevated intraocular pressure (IOP) and optic nerve damage.

Clinical Manifestations: Patients with PACG may present with symptoms of acute angle-closure crisis, including severe ocular pain, blurred vision, halos around lights, and nausea/vomiting. Chronic PACG may manifest with gradual visual field loss, optic nerve cupping, and elevated IOP on examination. Timely recognition of clinical signs and symptoms is crucial for initiating prompt treatment and preventing vision loss.

Diagnostic Criteria: Diagnosis of PACG requires a comprehensive ocular examination, including measurement of IOP, assessment of optic nerve morphology, visual field testing, and evaluation of angle structures. Ancillary tests such as gonioscopy, ultrasound biomicroscopy (UBM), or anterior segment optical coherence tomography (AS-OCT) may aid in confirming the diagnosis and guiding treatment decisions.

Management Strategies: Management of PACG aims to lower IOP, relieve pupillary block, and preserve visual function through a combination of medical, laser, and surgical interventions. Treatment modalities may include topical ocular hypotensive medications, laser peripheral iridotomy (LPI) to alleviate pupillary block, and surgical interventions such as trabeculectomy or glaucoma drainage devices for refractory cases.

Recent Advances: Recent innovations in PACG management focus on improving diagnostic accuracy, enhancing treatment efficacy, and minimizing treatment-related complications. Advancements such as microinvasive glaucoma surgery (MIGS) devices, novel laser techniques, and targeted pharmacotherapy offer potential benefits in achieving IOP control and preserving visual function in individuals with PACG.

Conclusion: Primary angle-closure glaucoma represents a significant public health concern, requiring vigilant screening, early diagnosis, and timely intervention to prevent irreversible vision loss. By staying informed about the latest research and innovations in PACG management, ophthalmologists can optimize patient outcomes and improve quality of life for individuals affected by this sight-threatening condition.

For further reading and reference:

• American Academy of Ophthalmology – Primary Angle-Closure Glaucoma: https://www.aao.org/eye-health/diseases/primary-angle-closure-glaucoma
• Glaucoma Research Foundation – Primary Angle-Closure Glaucoma: https://www.glaucoma.org/glaucoma/primary-angle-closure-glaucoma.php
• National Eye Institute – Glaucoma: https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma