Surgical management of chronic angle closure glaucoma
| Stage | Examination | Rationale |
|---|---|---|
| 1 Preoperative assessment | Indentation gonioscopy | Is there synechial closure of the angle? |
| Ultrasound B-scan | Ciliary body/processes enlarged Increased scleral thickness | |
| Ultrasound A-scan | Axial length—nanophthalmos | |
| Biomicroscopy | Lens opacity, ?extraction | |
| 2 Surgical technique | ?Preoperative diode Cyclophotocoagulation | Ciliary body shrinkage—allow time for this to occur |
| Viscoelastic | Postoperative maintenance of anterior chamber depth (use paracentesis site for postoperative management) | |
| Releasable sutures to scleral flap | Postoperative maintenance of anterior chamber depth | |
| (?consider lens extraction) | ||
| 3 Postoperative | Atropine | Prevent forward displacement of lens-iris diaphragm |
| Viscoelastic | If anterior chamber reformation is necessary |