Primary angle-closure glaucoma. A review 5 years after bilateral surgery.

It is now 20 years since Chandler (1952) advocated peripheral iridectomy for the prophylaxis of primary angle-closure glaucoma in the apparently uninvolved eye. Following later enthusiastic reports (Bain, 1957; Lowe, I962) this recommendation was accepted by perhaps the majority of ophthalmologists, but in travelling around the world I have found it firmly rejected by others. Opposition rests mainly on suggested surgical risks to a "normal" eye, and in late complications such as lens opacities. The surgical risks have been shown to be definite but small (Lowe, I962; Douglas and Strachan, I967; Ghoshal and Blaxter, I969; Luke, I969), but in the long term they are less than those following medical treatment (Bain, 1957; Lowe, I962; Douglas and Strachan, I967). More recently, Sugar (1970) reported considerable late refractive changes, whereas Kirsch (1 970) in a preliminary report and a recent personal communication (I972) stated that the fear of cataract is unwarranted. In view of these uncertainties, I planned a review of well-documented cases Io years after bilateral surgery. So many patients had died or could not be traced, however, that the period was reduced to 5 years.