Secondary angle closure glaucomas are a distinct entity from primary angle closure glaucoma (PACG). Unlike PACG, secondary angle closure glaucoma's have an identifable contributory factor/s for angle closure and obstruction of aqueous fow which is usually unrelieved by iridotomy. The treatment of each type of secondary angle closure glaucoma is varied, so identification of the primary cause aids in its effective management.How to cite this article: Annadurai P, Vijaya L. Management of Secondary Angle Closure Glaucoma. J Current Glau Prac 2014;8(1):25-32.

We report a case of a 39-year-old male who presented with bilateral severe diminution of vision, raised intraocular pressures despite maximal therapy, and corneal edema with endothelial decompensation six years following cosmetic iris prosthesis implantation. Right eye had progressed to glaucomatous optic atrophy, while the left eye showed advanced glaucomatous damage. The patient underwent iris implant removal with Ahmed glaucoma valve implantation in the left eye to achieve adequate control of the intraocular pressures. This case report highlights the dangers and risk of serious vision-threatening complications associated with these implants. Patients must be made aware of the possible complications, and their use should be discouraged in normal eyes.

A 58-year-old male presented with a progressive decrease in vision after he received intravitreal ozurdex injection 6 months ago for diabetic macular edema. Visual acuity in the right eye and left eye was 20/630 and 20/125, respectively. The right eye lens showed intralenticular dexamethasone implant. Intraocular pressure was 40 mmHg in the right eye and 16 mmHg in the left eye. Fundus examination revealed nonproliferative diabetic retinopathy with macular edema in both eyes. As the patient's intraocular pressure was not controlled by maximum medical therapy, he was listed for phacoemulsification with intraocular lens implantation.

Purpose: The aim of this study was to compare SD-OCT parameters between disc suspects and “pre-perimetric” glaucomatous discs classified on disc photos. Methods: Disc photos of suspicious discs with normal Humphrey visual fields (HVF) were graded as normal or pre-perimetric glaucomatous based on the consensus of three masked glaucoma specialists. RNFL and GCL-IPL maps of SD-OCT (Cirrus OCT) of these eyes were studied. Quantitative RNFL parameters were compared. Both groups were also compared with respect to parameters being classified as abnormal (at the 1% level), and the pattern of GCL-IPL and NFL maps were assessed qualitatively and classified as normal or pre-perimetric glaucomatous by a masked glaucoma specialist. Results: The average and inferior RNFL thicknesses were decreased in pre-perimetric glaucomatous eyes compared to normal eyes (p 0.01) The average, minimal, inferotemporal and inferior sector GCL-IPL thicknesses were decreased in pre-perimetric glaucomatous eyes (all P < 0.002) The highest AUC was for the inferior RNFL thickness (0.771) followed by average RNFL thickness (0.757) The sensitivity and specificity for any one abnormal RNFL parameter was 71.9% and 59.7%, for GCL-IPL parameters was 70% and 69.1% The positive (PLR) and negative likelihood ratios (NLR) were 1.78 and 0.47 for RNFL and 2.26 and 0.43 for GCL-IPL parameters. For the qualitative assessment of RNFL and GCL-IPL maps, the sensitivity, specificity, PLR and NLR were 75%, 77.2%, 3.29, and 0.32, respectively. Conclusion: Pre-perimetric disc suspects had greater OCT changes compared to normal disc suspects. Qualitative assessment of RNFL and GCL-IPL maps had the highest discriminatory ability.