A 60-year-old is diagnosed with primary angle-closure glaucoma (PACG). On gonioscopy, the trabecular meshwork is not visible for 360 degrees with 75% peripheral anterior synechiae (PAS). IOP is 38 mmHg despite maximum topical therapy. The MOST definitive surgical intervention is:

• A Laser peripheral iridotomy (LPI)
• B Nd:YAG laser peripheral iridotomy
• C Phacoemulsification with IOL implantation alone
• D Trabeculectomy with mitomycin C ✓

Explanation

With extensive PAS (75% of angle, 360° closure) and uncontrolled IOP despite maximal medical therapy, the trabecular meshwork is permanently damaged and angle-opening procedures (LPI, phacoemulsification) are unlikely to adequately control IOP. Trabeculectomy with MMC creates a new aqueous outflow pathway bypassing the obstructed trabecular meshwork and is the definitive surgical option. LPI is effective in acute angle closure or PAS <50% without significant trabecular damage.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.