A 55-year-old woman undergoes gonioscopy after a subacute angle-closure attack. The drainage angle shows peripheral anterior synechiae (PAS) occupying 270° of the trabecular meshwork. Her IOP remains elevated at 32 mmHg despite topical medications and YAG iridotomy. The NEXT step is:
- A Repeat YAG iridotomy
- B Filtering surgery (trabeculectomy) ✓
- C Argon laser peripheral iridoplasty
- D Phacoemulsification alone
Correct answer: B. Filtering surgery (trabeculectomy)
Explanation
With extensive (>180°) peripheral anterior synechiae, the drainage angle has permanent structural damage that cannot be reversed by iridotomy or iridoplasty. Iridotomy relieves pupillary block but cannot restore function of permanently synechially closed angles. At this stage, filtering surgery (trabeculectomy with/without antimetabolites) is needed to create an alternative drainage pathway. Phacoemulsification alone may deepen the angle and can be combined with trabeculectomy (phacotrabeculectomy) in selected cases, but trabeculectomy is the primary glaucoma intervention.
Reference: Khurana Comprehensive Ophthalmology, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.