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Invited Commentary
July 11, 2019

Surgical Management of Primary Angle-Closure Disease—Why Less Is More

Author Affiliations
  • 1USC Roski Eye Institute, Keck School of Medicine of USC, Los Angeles, California
  • 2Southern California Eye Institute, Los Angeles
JAMA Ophthalmol. 2019;137(10):1113-1114. doi:10.1001/jamaophthalmol.2019.2503

Primary angle-closure disease (PACD) is defined by the development of appositional contact or peripheral anterior synechiae (PAS) between the iris and trabecular meshwork, leading to impaired aqueous outflow and elevation of intraocular pressure (IOP), which increases the risk for developing glaucomatous optic nerve damage. The development of optic nerve damage in the context of iridocorneal angle closure defines primary angle-closure glaucoma (PACG). While PACG is less prevalent than primary open-angle glaucoma (POAG), PACG is a more frequent cause of bilateral blindness.1,2 Historically, clinical management of PACG resembled that of POAG, starting with medical and laser treatments followed by trabeculectomy or glaucoma drainage devices. However, the natural crystalline lens has been considered an important factor in the pathogenesis and development of PACD, and its removal can alleviate angle closure and PACD.3,4 Therefore, recent trends in surgical management of PACD are moving away from traditional glaucoma surgeries alone toward phacoemulsification (PEI) with or without goniosynechialysis (GSL) to achieve IOP lowering when noninvasive treatment options fail.5,6