Special Cases Of Angle Closure Glaucoma ; Iridoplasty ,Trabeculectomy Vs Combined Phaco Tabeculectomy

the cognition of the anatomy of the irido-corneal angle and the perfect mastery of the gonioscopy technique with identation make it possible to diagnose the forms of closure of the angle and indicate the adequate therapeutic management.

S.Slama  I.Abayahia.  M.Terahi     Ophtalmology service Nafissa Hamoud Hospital  Faculty of medicine  Algiers

we report 04 cases of particular form of angle closure ;  Irido-corneo-endothelial syndrome [iris naevus] without goniosynechies in a women of a 48 years old traited by trabeculectomy,  plateau iris syndrome with goniosynechies higher than 180 degrees in a woman of 51 years old traited by trabeculectomy,plateau iris configuration with pupillary block in a woman of 82 yeaurs old  traited by combined  phaco trabeculectomy and Plateau-like iris syndrome secondary to iridociliary polykystosis  without goniosynechies in a woman of 36 years old traited by iridoplasty.

Angle-closure glaucoma (ACG) is a group of diseases in which there is reversible (appositional) or adhesional (synechial) closure of the anterior-chamber angle. The angle closure may occur in an acute or chronic form. In the acute form, the IOP rises rapidly as a result of relatively sudden blockage of the trabecular meshwork  by the iris via papillary block mechanism. The chronic form may develop after acute angle closure where synechial closure of the angle persists, or it may develop over time as the angle closes from prolonged or repeated contact between the peripheral iris and the TM, which often leads to peripheral anterior synechiae (PAS) and functional damage to the angle.

The challenge of this disease primarily posits in prevention and diagnosis. Much like open-angle glaucoma, closed-angle glaucoma is typically an asymptomatic disease process in which patients are unaware of this illness until advanced visual loss occurs. Whereas acute angle closure glaucoma presents with a change in vision or with severe acute symptoms, chronic angle closure glaucoma tends to be discovered incidentally.Gonioscopy completed by ultrasound biomicroscopy  is a demanding skill and an essential part of the examination of a glaucoma patient to correct diagnosis is to be made and successful management instituted [ridoplasty , trabeculectomy , combined phaco trabeculectomy].