The Spectrum of Angle Closure Glaucoma

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The Spectrum of Angle Closure Glaucoma
Speakers: Joseph Sowka, OD, FAAO
Hours: 2hrs | 89380-GL

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This course will examine current terminology, pathophysiologic mechanism, and clinical appearance of angle closure glaucoma. Detailed discussion will examine both primary and secondary angle closure glaucomas. Therapeutic regimens for each condition are discussed in detail.

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Quiz

1. An asymptomatic patient presents with narrow angles by Von Herrick screening and you do gonioscopy. You note that the pigmented trabecular meshwork blocked by iris, but there is no peripheral anterior synechiae (PAS) and the disc and IOP are normal. What is the best term used to describe this patient?*

A - Primary angle closure suspect

B - Primary angle closure

C - Primary angle closure glaucoma

D - Primary angle closure attack

2. An asymptomatic patient presents with narrow angles by Von Herrick screening and you do gonioscopy. The pigmented trabecular meshwork is blocked by the iris for 1800 and you note also an elevated IOP along with glaucomatous neuropathy and field loss. What is the best term to describe this patient?*

A - Primary angle closure suspect

B - Primary angle closure

C - Primary angle closure glaucoma

D - Primary angle closure attack

3. What is the glaucomatous mechanism of plateau iris syndrome?*

A - Primary angle closure glaucoma (ACG) with pupil block

B - Primary angle closure without pupil block

C - Secondary angle closure with pupil block

D - Secondary angle closure without pupil block

4. What would be the best diagnosis of a patient with angle closure glaucoma who presents with a history of episodic blurred vision and halos around lights at night, but is otherwise asymptomatic in the office?*

A - Plateau iris syndrome

B - Acute angle closure attack

C - Chronic angle closure

D - Subacute (intermittent) angle closure

5. What is the most common type of primary angle closure glaucoma?*

A - Plateau iris syndrome

B - Acute angle closure attack

C - Chronic angle closure

D - Subacute (intermittent) angle closure

6. What is the mechanism of angle closure in patients using Topamax (topiramate)?*

A - Primary angle closure with pupil block

B - Primary angle closure without pupil block

C - Secondary angle closure with pupil block

D - Choroidal expansion and effusion

7. What is the clinical difference in the appearance of pupil block angle closure and choroidal expansion angle closure?*

A - The IOP is higher in pupil block

B - The IOP is higher in choroidal expansion

C - The anterior chamber is flat in choroidal expansion whereas there is iris bombé in pupil block

D - The anterior chamber is flat in pupil block whereas there is iris bombé in choroidal expansion

8. Which is the best management for patients with plateau iris syndrome?*

A - Argon laser iridoplasty

B - Lens extraction

C - Chronic medical therapy

D - Laser peripheral iridotomy

9. What is the most appropriate therapy for a patient with angle closure from Topamax usage?*

A - Laser peripheral iridotomy

B - Topical steroids

C - Pilocarpine

D - Argon laser iridoplasty

10. Upon routine examination, you note that a patient has bilaterally narrow angles. Gonioscopically, you note no angle structures. There appears to be no peripheral anterior synechiae. Intraocular pressure is 15 mm Hg OU. There are no other abnormalities. The patient denies eye or head pain and has never seen halos around lights at night. The patient undergoes laser peripheral iridotomy successfully. However, afterwards there is no change in the angle appearance or structures and the patient still seems capable of closure and there is a double hump sign on gonioscopy. What is the most appropriate diagnosis for this patient?*

A - Plateau iris syndrome

B - Chronic primary angle closure with pupil block

C - Primary acute angle closure attack

D - Intermittent (Subacute) angle closure glaucoma

11. An asymptomatic patient presents with narrow angles by Von Herrick screening and you do gonioscopy. You note that the pigmented trabecular meshwork blocked by iris, but there are several clock hours of peripheral anterior synechiae (PAS) and the disc and IOP are normal. What is the best term used to describe this patient?*

A - Primary angle closure suspect

B - Primary angle closure

C - Primary angle closure glaucoma

D - Primary angle closure attack

12. Which of the following laser treatments relieves pupil block?*

A - Laser iridotomy

B - Selective laser trabeculoplasty

C - Argon laser iridoplasty

D - Cyclophotocoagulation

13. Which term refers to necrotic lens capsule in angle closure disease?*

A - Exfoliation syndrome

B - Pseudo-exfoliation syndrome

C - Glaukomflecken

D - Capsular turgescence

14. Which medication works too slowly to be of much use in lowering intraocular pressure in acute angle closure disease?*

A - Beta blockers

B - Oral carbonic anhydrase inhibitors

C - Alpha adrenergic agonists

D - Prostaglandin analogs (PGA)

15. Which medication works especially well in eyes with primary chronic angle closure glaucoma?*

A - Beta blockers

B - Oral carbonic anhydrase inhibitors

C - Alpha adrenergic agonists

D - Prostaglandin analogs (PGA)

16. The EAGLE study favored what treatment for chronic angle closure eyes?*

A - Laser iridotomy

B - Lens extraction

C - Iridoplasty

D - Chronic topical medical therapy

17. The ZAP study showed that laser iridotomy conferred what percentage of risk reduction to angle closure suspect eyes?*

A - 23%

B - 47%

C - 68%

D - 100%

18. What is the glaucomatous mechanism of phacomorphic glaucoma?*

A - Primary angle closure glaucoma (ACG) with pupil block

B - Primary angle closure without pupil block

C - Secondary angle closure with pupil block

D - Secondary angle closure without pupil block

19. What is the glaucomatous mechanism of ciliary block/malignant glaucoma?*

A - Primary angle closure glaucoma (ACG) with pupil block

B - Primary angle closure without pupil block

C - Secondary angle closure with pupil block

D - Secondary angle closure without pupil block

20. What is the glaucomatous mechanism of neovascular glaucoma?*

A - Primary angle closure glaucoma (ACG) with pupil block

B - Primary angle closure without pupil block

C - Secondary angle closure with pupil block

D - Secondary angle closure without pupil block

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