ACUTE ANGLE-CLOSURE GLAUCOMA IN EMERGENCY MEDICINE TREATMENT AND MANAGEMENT Awan Buana
Faculty of Medicine Universitas Jenderal Achmad Yani
Cimahi, Indonesia
Abstract
Of the nearly 67 million patients with glaucoma worldwide, it has been estimated that one-half are of Asian descent. The prevalence of angle-closure glaucoma (ACG), much of which is primary angle closure, has been shown to be higher than that of other types of glaucoma among Asian persons. Population studies have determined that the ratio of open-angle glaucoma (OAG) to ACG in Chinese individuals range from 1:1 to 2.6:1. Primary ACG (PACG) is more common than previously recognized and is a leading cause of bilateral blindness worldwide.
In primary OAG, while the resistance to aqueous outflow is known to be increased, structures proximal to the trabecular meshwork do not add to the resistance to aqueous outflow and the pathologic resistance to outflow resides in the meshwork itself.
Early diagnosis and treatment of most forms of ACG can be invaluable, and sometimes curative. Accordingly, understanding the pathophysiology is essential if proper treatment is to be initiated. Also, screening patients at greatest risk for angle closure can be beneficial in reducing the number of patients who develop these diseases and in reducing the risk of blindness.
In primary angle closure, there is no identifiable underlying pathology- there is only an anatomical predisposition to pupillary block. In secondary angle closure, an identifiable pathologic cause, such as an intumescent lens, iris neovascularization, chronic inflammation, corneal endothelial migration, or epithelial ingrowth, initiates the angle closure.
