Angle-Closure Glaucoma with ≥180° of Iridotrabecular Contact (ITC) on Gonioscopy

This protocol applies to patients in whom gonioscopy demonstrates ≥180 degrees of iridotrabecular contact (ITC), together with peripheral anterior synechiae (PAS) and/or elevated intraocular pressure (IOP).

Clinical scenario

Gonioscopy confirms ≥180° of iridotrabecular contact with peripheral anterior synechiae (PAS) and/or elevated IOP. This constellation is consistent with primary angle closure (PAC) when glaucomatous optic neuropathy is absent, or primary angle-closure glaucoma (PACG) when optic neuropathy is present.

Treatment approach

The protocol specifies a laser-based intervention directed at the iris as the primary step for relieving angle crowding. Full technique details, sequencing, and procedural specifics are in the complete protocol.

Goal: Confirm by repeat gonioscopy that the anterior chamber angle is open following the intervention.

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References

DOI: 10.1016/j.ophtha.2025.12.030

Primary angle closure (PAC): ≥180 degrees ITC with PAS and/or elevated IOP but no glaucomatous optic neuropathy
Primary angle-closure glaucoma (PACG): ≥180 degrees ITC with PAS and/or elevated IOP and glaucomatous optic neuropathy
Laser peripheral iridotomy may be performed using a thermal (i.e., argon or diode) and/or Nd:YAG laser.
Confirm by repeat gonioscopy that the angle is open after intervention.

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