Ophthalmology in China

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The indications of initial treatment for angle-closure glaucoma

ZHANG Ming1, FAN Su-jie2, LIANG Yuan-bo3, HAN Wei2, WANG Ning-li4.   

  1. 1. Department of Ophthalmology, Affiliated Zhong Da Hospital of Southeast University, Nanjing 210009, China; 2. Handan Eye Hospital, Handan 056001, China; 3. Eye and Optometry Hospital, Wenzhou Medical University, Wenzhou 325027, China; 4. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
  • Received:2016-12-22 Online:2017-01-25 Published:2017-01-20
  • Contact: LIANG Yuan-bo, Email: yuanboliang@126.com


Objective To compare the Chinese conventional practice patterns of primary angle-closure glaucoma (PACG) with American Academy of Ophthalmology recommended practice patterns in a setting of tertiary eye hospital in China.  Design Retrospective case series. Participants 148 eyes with acute angle closure glaucoma (AACG) and 245 eyes with chronic angle closure glaucoma (CACG) between October 2005 and March 2007 at Handan Eye Hospital. Methods All eyes were undergone laser peripheral iridotomy (LPI), with a follow up time of 1-18 months. Based the database, we assumed to treat the patients with Chinese conventional practice patterns, to see the proportions of overtreatment and the potential undertreatment. Main Outcome Measures The ratio of overtreatment and undertreatment. Results In accordance with conventional practice patterns for PACG in China, 45 AACG eyes and 89 CACG eyes will take trabeculectomy, among which 46.7% (21/45) of AACG eyes and 49.4% (44/89) of CACG eyes can be well controlled by LPI, respectively. With laser preferred strategy, the rate of inadequate treatment will be increased from 10.8%(16/148)to 29.7% (44/148) in AACG eyes and from 18.4% (45/245) to 42.4% (104/245) in CACG eyes. Conclusion Filtery surgery in PACG is seriously overdone in China with conventional practice patterns. The rate of inadequate treatment will be increased remarkablely with laser preferred practice pattern, about 2-3 times compared with the traditional mode of filtration surgery. Therefore, taking both the degree of PAS and optic nerve damage into the consideration of choosing filtration surgery or not for PACG patients, may be utmost to avoid excessive treatment and reduce the inadequate treatment. (Ophthalmol CHN, 2017, 26: 15-20)

Key words: primary angle closure glaucoma, laser iridotomy, trabeculectomy