Secondary Angle Closure Glaucoma Definition

In secondary angle closure glaucoma as in primary angle closure glaucoma, the increase in intraocular pressure is due to blockage of the trabecular meshwork. However, the primary configuration of the anterior chamber is not the decisive factor.

The most important causes: Rubeosis iridis. Neovascularization draws the angle of the anterior chamber together like a zipper (neovascular glaucoma).

Ischemic retinal disorders such as diabetic retinopathy and retinal vein occlusion can lead to rubeosis iridis with progressive closure of the angle of the anterior chamber. Other forms of retinopathy or intraocular tumors can also cause rubeosis iridis. The prognosis for eyes with neovascular glaucoma is poor (see Fig. 10.20a and b).

Trauma. Post-traumatic presence of blood or exudate in the angle of the anterior chamber and prolonged contact between the iris and trabecular mesh-work in a collapsed anterior chamber (following injury, surgery, or insufficient treatment of primary angle closure) can lead to anterior synechiae and angle closure without rubeosis iridis.

Neovascular glaucoma: secondary angle closure glaucoma with rubeosis iridis.

Neovascular glaucoma: secondary angle closure glaucoma with rubeosis iridis.

Rubeosis Iridis Causes

Fig. 10.20 a Rubeosis iridis: Neovascularization (arrow) is visible on the surface of the iris. Contraction everts the posterior pigmented epithelium of the iris on to the anterior surface of the iris (arrow) in a condition known as ectropion uveae.

b Gonioscopy: The angle of the anterior chamber is closed, and the trabecular meshwork is no longer visible (arrow). Rubeosis iridis has drawn the angle of the anterior chamber together like a zipper.

Fig. 10.20 a Rubeosis iridis: Neovascularization (arrow) is visible on the surface of the iris. Contraction everts the posterior pigmented epithelium of the iris on to the anterior surface of the iris (arrow) in a condition known as ectropion uveae.

b Gonioscopy: The angle of the anterior chamber is closed, and the trabecular meshwork is no longer visible (arrow). Rubeosis iridis has drawn the angle of the anterior chamber together like a zipper.

Treatment of secondary glaucomas:

H Medical therapy of secondary glaucomas is usually identical to the treatment of primary chronic open angle glaucoma.

Secondary glaucomas may be caused by many different factors, and the angle may be open or closed. Therefore, treatment will depend on the etiology of the glaucoma. The underlying disorder is best treated first. Glaucomas with uveitis (such as iritis or iridocyclitis) initially are treated conservatively with anti-inflammatory and antiglaucoma agents. Surgery is indicated where conservative treatment is not sufficient.

H The prognosis for secondary glaucomas is generally worse than for primary glaucomas.

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