Chronic Angle-Closure Glaucoma with ≥180° Iridotrabecular Contact and No Intraocular Pressure Elevation

This protocol addresses a specific early presentation of chronic angle-closure glaucoma in which extensive iridotrabecular contact is present but intraocular pressure remains normal, no peripheral anterior synechiae have formed, and there is no glaucomatous optic neuropathy.

Clinical scenario: The anterior chamber angle shows ≥180 degrees of iridotrabecular contact (ITC) — meeting the threshold for a primary angle-closure suspect — yet without intraocular pressure elevation, peripheral anterior synechiae (PAS), or glaucomatous optic neuropathy. This is a structurally high-risk configuration requiring active clinical decision-making despite the absence of overt damage.

Treatment approach (partial overview)

A laser-based procedure targeting the peripheral iris is among the interventions considered in this scenario, with the goal of reducing future risk — the full structured regimen specifies the indications, sequencing, and clinical decision points.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1016/j.ophtha.2025.12.030

Primary angle-closure suspect (PACS): ≥180 degrees iridotrabecular contact (ITC) without intraocular pressure (IOP) elevation, peripheral anterior synechiae (PAS), or glaucomatous optic neuropathy.

With PACS, LPI should be considered to reduce the risk of developing AACC or progression to PAC.

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