Table 2

Surgical management of chronic angle closure glaucoma

1 Preoperative assessmentIndentation gonioscopyIs there synechial closure of the angle?
Ultrasound B-scanCiliary body/processes enlarged
Increased scleral thickness
Ultrasound A-scanAxial length—nanophthalmos
BiomicroscopyLens opacity, ?extraction
2 Surgical technique?Preoperative diode
Ciliary body shrinkage—allow time for this to occur
ViscoelasticPostoperative maintenance of anterior chamber depth
(use paracentesis site for postoperative management)
Releasable sutures to scleral flapPostoperative maintenance of anterior chamber depth
(?consider lens extraction)
3 PostoperativeAtropinePrevent forward displacement of lens-iris diaphragm
ViscoelasticIf anterior chamber reformation is necessary