terminology and guidelines for glaucoma ii - Kwaliteitskoepel

OCCLUDABLE ANGLE:
“Occludable” is not an objective evidence - based finding but a clinical diagnosis. Since an occludable angle is
defined as one that has high risk of closure, it must be treated with iridotomy/iridectomy to eliminate the pupillary
block component.
If the iridotomy is patent, should the angle not deepen, iridoplasty may be considered, depending on the main
mechanism underlying the risk of angle occlusion. Topical pilocarpine or dapripazole treatment should be considered
whilst awaiting iridotomy / iridectomy.
NARROW ANGLE:
The term “narrow angle glaucoma” does not describe whether the main cause of IOP increase is primary
impairment of trabecular outflow facility or mechanical obstruction of the trabeculum by iris apposition or synechial
closure. Both mechanisms may co-exist in an eye with a narrow anterior chamber angle. Therefore the
term “narrow angle glaucoma” should be avoided as non-specific.
If an occludable angle is present (i.e. in addition to POAG), this should be referred as POAG with an occludable
angle or with risk of angle-closure (See also Ch. 2.4.3).
If intermittent angle-closure is present, the condition should be considered, and treated, as angle-closure glaucoma.
If a case of POAG has a narrow angle, it should be labeled as POAG with narrow angle approach.
Ch. 2 - 17 EGS