By T. Thygesen
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Additional resources for Primary Angle-Closure and Angle-Closure Glaucoma
PAS develop insidiously from the most narrow, upper angle sector and downwards39. indd 41 20-6-2007 15:04:40 42 Diagnostic methods in PAC As mentioned under “Normal anatomy of the chamber angle” (2: The uveal meshwork (iris processes)), it may be difficult to distinguish between PAS and a physiologically pronounced uveal meshwork with iris processes (see fig. 15a-b). PAS with PAC are more solid when compared to the porous lace-like uveal meshwork, and furthermore they are clearly formed by the iris stroma.
For instance, if one is unaware that the contact lens has been placed at an angle and not on the optical axis in the centre of cornea, the pigmented trabecular meshwork may be visualised, and the angle may then incorrectly be perceived as being open. Furthermore, the above situation will often result in lens indentation and thereby affect the degree of opening. In order to avoid these problems, a standardised examination technique is aimed at as described in the previous section: Examination in the primary position for open or narrow angle (Posner and Goldmann lens).
This was not, however, generally accepted until the 1950s. The work of Barkan was to a high degree inspired by the studies of the Swedish ophthalmologist Bengt Rosengren (1930-1931) concerning the relationship between the axial chamber depth and acute glaucoma. However, angle-closure due to plateau iris was not described until 1958 by Rosengren’s colleague Ragnar Tørnquist12, and it is only in the last decade that this form of PAC has generally become accepted as representing an important clinical entity.