Angle Recession Glaucoma
Angle Recession Glaucoma Treatment continued...
If your ophthalmologist prescribes medicines to help lower the pressure inside your eye, properly applying the medication and complying with your eye doctor’s instructions are very important (see How to Instill Your Eyedrops). Not doing so could result in an additional increase in IOP that can further affect the optic nerve and cause permanent vision loss.
The treatment of angle recession glaucoma depends on how severe your eye is injured and how well your eye heals following this injury. If you are diagnosed with angle recession, then your treatment will be similar to that of POAG. (For a complete discussion of the treatment of POAG, see Primary Open-Angle Glaucoma.)
The treatment of angle recession glaucoma includes monitoring your IOP as well as reducing it through the use of medicated eyedrops (see Medications).
- Eyes with normal IOP and with angle recession involving more than 180° of the iris are routinely examined for an indefinite time period to monitor for the development of late glaucoma.
- If the IOP in your eye is abnormally elevated, your ophthalmologist will decide whether or not to begin medical treatment based on your overall risk of vision loss.
- To assess this risk, your eye doctor takes into account how high your IOP is elevated, the appearance of your optic nerve, and the findings of your visual field tests.
- Treatment is most often indicated when your IOP is greater than 25-28 mm Hg and/or when changes in your optic nerve or your visual field are documented over time.
- Each person’s response to medical treatment is different.
- Treatment with medicated eyedrops may be effective in cases of mild-to-moderate angle recession, while elevated IOP in eyes with extensive injury to the angle may eventually no longer respond to medications.
- Severe cases of angle recession may not respond to even aggressive medical treatment and typically have a poorer overall prognosis.
The goal of therapy is to reduce IOP, typically by using medicated eyedrops. These medications must often be used for a long time. Each person’s response to medication varies and changes with time, and IOP control may deteriorate despite the use of multiple medications. Therefore, your IOP is continually monitored, especially whenever medications are changed or discontinued.
- The preferred drugs for lowering IOP include beta-antagonists, alpha-agonists, and carbonic anhydrase inhibitors, all of which reduce the amount of fluid (aqueous humor) in the eye. Beta-antagonists are typically the first choice, and alpha-agonists and/or carbonic anhydrase inhibitors are added later.
- Prostaglandin analogs and miotics increase the outflow of fluid (aqueous humor) from the eye. Prostaglandin analogs may be useful, but miotics are not routinely recommended.
In angle recession glaucoma, surgery is recommended when the maximum amount of medicine has been tried and failed to reduce IOP and when the risk of vision loss outweighs the risk of surgery. Either laser surgery or conventional incisional surgery in an operating room may be needed.
Although favorable results have been reported for surgical intervention of angle recession glaucoma, success rates are lower when compared to other forms of glaucoma. Your eye doctor will discuss the risks and benefits of each procedure with you.