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Medical Therapy in Angle Closure Glaucoma

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Primary Angle Closure Glaucoma (PACG)

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Abstract

Medical therapy plays essential roles in the management of angle closure glaucoma (ACG) both in intraocular pressure (IOP) reduction and in modifying angle anatomy. The administration of multiple topical and systemic hypotensive agents usually enable IOP reduction rapidly. Miotics help to prepare the iris for a definitive laser iridotomy or iridoplasty. Anti-inflammatory and analgesic medications must also be employed to reduce associated symptoms. The use of miotics must be cautious as it may worsen  angle closure mechanisms like ciliary block and lens-related mechanism. For chronic ACG, medical treatment could be a mainstay if IOP remains persistently high after laser or surgical treatment. All anti-hypertensive agents work with variable effects depending on the stage and mechanism of angle closure. The relevant mode of action, efficacy, and side effect of each different class of hypotensive medications are described in detail. Prostaglandins are the most effective topical hypotensive agent and could reduce IOP in variable degrees of angle closure. New medications and molecules, still novel for ACG, could have potential use in the future.

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Acknowledgment

Patcharaporn Jaru-ampornpan, MD. for contribution on table and figure.

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Authors and Affiliations

  1. Glaucoma Research Unit, Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand

    Prin Rojanapongpun & Visanee Tantisevi

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  1. Prin Rojanapongpun
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  1. Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong Eye Hospital, Hong Kong SAR, China

    Clement C.Y. Tham

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Rojanapongpun, P., Tantisevi, V. (2021). Medical Therapy in Angle Closure Glaucoma. In: Tham, C.C. (eds) Primary Angle Closure Glaucoma (PACG). Springer, Singapore. https://doi.org/10.1007/978-981-15-8120-5_4

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  • DOI: https://doi.org/10.1007/978-981-15-8120-5_4

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