Subacute (Intermittent) Primary Angle-Closure Glaucoma: Understanding the Condition and Its Treatment


Subacute primary angle-closure glaucoma, also known as intermittent primary angle-closure glaucoma, is a form of primary angle-closure glaucoma (PACG) where the episodes of angle closure are not continuous and the intraocular pressure (IOP) can fluctuate between normal and elevated. This condition can lead to optic nerve damage if left untreated.

Symptoms and Causes of Subacute PACG

Symptoms of subacute PACG can include sudden onset of eye pain, headache, blurred vision, halos around lights, and nausea. These symptoms may come and go, and may not be present during the intervals between episodes. The cause of subacute PACG is related to the anatomy of the eye, specifically a narrow angle between the iris and cornea. This narrow angle can be caused by a variety of factors such as age, hyperopia (farsightedness), and certain types of cataracts.

Diagnosis and Treatment of Subacute PACG

Subacute PACG is typically diagnosed through a comprehensive eye exam, including measuring the IOP, examining the angle of the eye, and examining the optic nerve. Gonioscopy, a procedure that allows the doctor to see the angle of the eye, is also done to confirm the diagnosis.

The main goal of treatment for subacute PACG is to lower the IOP and protect the optic nerve. This may include medications such as ocular hypotensive agents, which lower the IOP, and laser therapy such as laser peripheral iridotomy (LPI), which creates a small hole in the iris to allow the aqueous humor to flow more freely.

In some cases, surgery may be recommended. The most common surgery for subacute PACG is Trabeculectomy, a procedure that creates a new drainage channel for the aqueous humor to flow out of the eye, lowering the IOP.

Monitoring

Subacute PACG is a chronic condition that requires regular monitoring to ensure that the treatment plan is effective. The patient will need to have regular eye exams to check the IOP, angle of the eye, and visual field. If the treatment is not effective, the treatment plan may need to be adjusted.

Prevention

While there is no known way to prevent subacute PACG, early detection and treatment can help slow the progression

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