The treatment of primary open-angle glaucoma is aimed at controlling the development of the disease or slowing its progression as much as possible, in order to maximize the preservation of vision in most patients by lowering intraocular pressure to achieve this objective. Considering that individuals' optic nerves have different tolerances to ocular pressure, it's impossible to establish a single value to measure whether the intraocular pressure of glaucoma is under control. Some patients with normal intraocular pressure still experience progressive visual impairment, while others with high intraocular pressure can tolerate it for a long time without showing damage. Therefore, in the follow-up treatment of open-angle glaucoma, monitoring intraocular pressure alone is insufficient; one must also track changes in the optic disc and visual field defects. If glaucomatous damage is progressing, the intensity of anti-glaucoma treatment should be increased, and some protective measures should be taken to preserve visual function.
The therapeutic purpose for primary angle-closure glaucoma depends on the duration and severity of the condition. For acute angle-closure glaucoma, the main goals are to reduce intraocular pressure and relieve pupillary blockage. Raising the pupil block also relies on lowering intraocular pressure, making the reduction of intraocular pressure the primary task. Hypertonic agents can concentrate the vitreous humor, combined with carbonic anhydrase inhibitors to reduce aqueous humor formation, which effectively moves the lens-iris diaphragm backward. At this point, using miotics makes it easier to reopen the angle. In pre-clinical, threatened remission phases, and angle-closure glaucoma, the aim is to remove the pupil block and prevent attacks. Simply relying on miotics is not reliable; iridectomy or laser peripheral iridotomy should be performed. Chronic angle-closure glaucoma aims to control seizures, but only when the angle opening is more than 1/2, in principle, laser-based iridotomy is still recommended. For angles less than 1/2 open, filtration surgery is advised, and follow-up focuses on preserving visual function from damage.
Early treatment of congenital glaucoma mainly involves removing barriers to aqueous outflow, such as goniotomy and trabeculectomy. For advanced cases, lowering intraocular pressure primarily protects visual function, such as through filtration surgery. Drug treatment is generally ineffective.
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