NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
NHMRC Glaucoma Guidelines - ANZGIG
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<strong>NHMRC</strong> GUIDELINES FOR THE SCREENING, PROGNOSIS, DIAGNOSIS, MANAGEMENT AND PREVENTION OF GLAUCOMA<br />
Chapter 1 – Recommendations and Evidence statements<br />
Recommendation<br />
Recommendation 13<br />
If indicated, perform<br />
prophylactic laser<br />
peripheral iridotomy<br />
in both eyes to prevent<br />
progressive anterior<br />
segment damage<br />
Evidence Statements<br />
Summary of common laser interventions:<br />
Laser options for specific glaucoma classification<br />
and stages – Angle closure – patients with narrow<br />
angles/suspected angle closure but low risk status<br />
Evidence supports the practice of monitoring patients with<br />
suspected angle closure, who are at low risk of immediate<br />
closure, until there is evidence of:<br />
−−<br />
elevated intraocular pressure<br />
−−<br />
progressive narrowing, or<br />
−−<br />
development of synechial angle closure.<br />
Evidence supports the importance of ensuring that individuals<br />
who are being monitored for angle closure (rather than being<br />
actively treated) are:<br />
−−<br />
fully informed of the risks of monitoring<br />
−−<br />
aware of symptoms of closure, and<br />
−−<br />
capable of accessing immediate treatment.<br />
Where these factors cannot be guaranteed, the patient<br />
should be treated as if at high risk.<br />
Summary of common laser interventions:<br />
Laser options for specific glaucoma classification and<br />
stages – Angle closure – patients with suspected angle<br />
closure and high-risk status<br />
Evidence supports using laser iridotomy for both eyes as the<br />
treatment of choice for patients with suspected angle closure,<br />
who are at high risk of closure.<br />
Summary of common laser interventions:<br />
Laser options for specific glaucoma classification<br />
and stages – Angle closure – patients with acute<br />
angle closure<br />
Evidence supports using laser iridotomy with adjunctive<br />
pre-operative medication, as the treatment of choice for<br />
patients with acute angle closure.<br />
Expert/consensus opinion suggests that in patients who<br />
experience acute angle closure in one eye, the fellow eye<br />
is at high risk of future closure and therefore prophylactic<br />
iridotomy can be clinically indicated.<br />
Evidence strongly supports using medication to rapidly reduce<br />
intraocular pressure as a short-term measure pre-operatively,<br />
in patients with acute angle closure glaucoma.<br />
Summary of common laser interventions:<br />
Laser options for specific glaucoma classification and<br />
stages – Angle closure – patients with chronic angle<br />
closure and chronic angle closure glaucoma<br />
Evidence supports using laser peripheral iridotomy as the<br />
treatment of choice in patients with chronic angle closure.<br />
Expert/consensus opinion suggests that more than one<br />
patent peripheral iridotomy confers no additional benefit.<br />
Evidence<br />
Statement<br />
Grade<br />
C<br />
C<br />
C<br />
C<br />
A<br />
C<br />
24 National Health and Medical Research Council