Laser therapy and angle-closure glaucoma.

All forms of primary and secondary pupillary block angle-closure glaucoma result in an increased resistance to aqueous flow at the pupil margin. As the pressure in the posterior chamber increases, the iris bows forward until the trabecular meshwork is occluded and aqueous outflow is interrupted. Most pupillary block glaucomas are ocular urgencies and require immediate medical therapy to lower intraocular pressure. The definitive treatment for pupillary block is laser therapy. By creating a hole in the iris, the pressure in the anterior and posterior chambers is equalized, allowing the angle to remain open. This discussion reviews the indications, contraindications, and techniques involved in the laser management of angle-closure glaucomas.