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What is Best laser treatment in early stage of primary angle closure glaucoma (PACG) - and explain in detail?
Ans. is 'a' i.e., Laser iridotomy Treatment of angle closure glaucomao Definitive treatment (treatment of choice) is surgery. However, intially drugs are used to decrease IOP during an acute attack. Approach of treatment is as follow's:-Start i.v. mannitol or i.v. acetazolamideWhen IOT starts falling, start topical pilocarpine or p-blocker (timolol).Apraclonidine/latanoprost may be added.Once IOT is reduced, surgery' is done.o Topical pilocarpine 2% is the preferred antiglaucomatous drugo After control of IOP, Laser (Nd : YAG) peripheral irodotomy is the definitive management of choice. If laser is not available surgical peripheral iridectomy is the procedure of choice. Other surgical procedures used are fiIteration surgeries (like trabeculectomy , deep sclerotomy, Viscoanulostomy).o Symptomatic treatment during an attack also includes analgesics, antiemetic and topical corticosteroids to reduce inflammation. Mydriatics (e.g. atropine) are contraindicated as they precipitate glaucomao PACG is a bilateral disease, the fellow eye is at risk of developing an acute attack in 50% cases in future. Therefore a prophylactic peripheral laser iridotomy should be performed in the fellow eye.