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Title	Pilocarpine induced “partial angle closure” in a narrow but open anterior chamber angles: A case report.
Abstract Nr.	142

Purpose	Partial closure of anterior chamber angle can be possible in patients with narrow but open angles on account of a covert angle closing mechanism. This situation can lead to ocular hypertension and in some cases to open angle glaucoma unless relieved by a peripheral iridectomy. Muscarinic action of pilocarpine may affect the anterior segment structures of the eye, such as contraction of ciliary body, relaxation of lens zonules, forward movement of the lens and even anterior chamber narrowing. Recently a case is referred to where “partial angle closure” was present due to this combined mechanism: Pilocarpine induced “partial angle closure” in a narrow but open anterior chamber angles.
Methods	Indentation gonioscopy was done in this case before application of any medication, after addition of Pilocarpine to achieve target IOP and after omitting Pilocarpine eye drop in both eyes. The Spaeth gonioscopy grading system was followed.
Results	64 years female, Gonioscopy findings: RE C 30 f, LE C 20 f, left eye appeared open but narrow angle recess, was on Beta blocker in BES since 2006. Pilocarpine was added to achieve the target IOP in January 2008. After 6 months’ use of Pilocarpine, IOP was 14 and 34 mm of Hg in the right and the left eye and no angle structures were seen in the left eye. Pilocarpine was stopped in BEs. After gonioscopy YAG peripheral Iridectomy was done in the left eye. Patient was advised for YAG PI in the right eye. Patient is on combination of carbonic anhydrase inhibitor and beta blocker in both eyes and IOP was 16 and 14 mm of Hg in the right and the left eye respectively.
Conclusion	1) Pilocarpine can precipitate such “partial angle closure” in a narrow but open anterior chamber angles. 2) “Partial angle closure” can be relieved by YAG PI.

Author 1

Last name	CHAKRAVARTI
Initials	T
Department	Glaucoma
City	Rotterdam