Glaucoma Services, Aravind Eye Hospital, Poonamallee High Road, Noombal, Chennai, Tamil Nadu, India.
Indian J Ophthalmol. 2024 Oct 1;72(10):1535-1536. doi: 10.4103/IJO.IJO_2905_23. Epub 2024 Sep 27.
Secondary angle closure glaucoma (SACG) can be quite puzzling and can challenge even an experienced glaucoma surgeon. Unlike primary angle closure glaucoma, SACG can have various ocular and systemic associations. A careful review of the symptoms and past ocular and surgical history cannot be overemphasized. Some of the SACG can be refractory, requiring drainage devices. However, sometimes, all it takes is a prompt laser iridotomy. This can significantly reduce ocular morbidity and, in some situations, even blindness. Gonioscopy, often an underutilized technique, is critical in making the right diagnosis. With the advent of imaging techniques such as anterior segment optical coherence tomography and ultrasound biomicroscopy, one can easily pick up the etiology and treat early.
As many cases of SACG present acutely, it is critical that one makes a prompt diagnosis. We present here a video bouquet of illustrated examples of SACG and the steps to identify the cause by using different imaging techniques. Through this video, we aim to make the diagnosis of SACG a simpler, more streamlined, and logical process that will help in the accurate diagnosis and management.
This video demonstrates various etiologies of secondary angle closure and methods to identify and treat the same.
Secondary angle closure can occur either with or without pupillary block. SACG with pupillary block involves mechanisms such as seclusio pupillae, aphakic/pseudophakic glaucoma, phacomorphic glaucoma, and silicon oil-induced glaucoma. In contrast, there are various other etiologies causing anterior pulling or posterior pushing mechanisms that contribute to non-pupillary block SACG. We discuss all of these, along with the imaging modalities needed to identify the same.
继发性闭角型青光眼（SACG）可能非常棘手，即使是经验丰富的青光眼外科医生也可能感到困惑。与原发性闭角型青光眼不同，SACG 可能与各种眼部和全身因素有关。仔细审查症状以及过去的眼部和手术史是非常重要的。一些 SACG 可能难以治疗，需要引流装置。然而，有时，及时进行激光虹膜切开术就足够了。这可以显著降低眼部发病率，在某些情况下甚至可以避免失明。房角镜检查，通常是一种未充分利用的技术，对于做出正确的诊断至关重要。随着前节光学相干断层扫描和超声生物显微镜等成像技术的出现，人们可以轻松地发现病因并进行早期治疗。
由于许多 SACG 是急性发作的，因此迅速做出诊断至关重要。我们在此展示一系列 SACG 的实例视频，以及使用不同成像技术来识别病因的步骤。通过这个视频，我们旨在使 SACG 的诊断过程更加简单、流畅和具有逻辑性，从而有助于准确诊断和管理。
本视频演示了继发性闭角型青光眼的各种病因以及识别和治疗这些病因的方法。
继发性闭角型青光眼可以发生在瞳孔阻滞或无瞳孔阻滞的情况下。瞳孔阻滞性 SACG 涉及瞳孔阻滞、无晶状体/人工晶状体青光眼、白内障青光眼和硅油诱导性青光眼等机制。相比之下，还有其他各种导致前房牵拉或后房推动的病因导致非瞳孔阻滞性 SACG。我们讨论了所有这些病因，以及需要识别这些病因的成像方式。
