Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was months (range 13.8–150.6 months). Sixty-eight eyes (86.1%) underwent additional medical, laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10×？logMAR visual acuity score for all patients significantly declined from at baseline to ( , ) at the last followup. Conclusions. Most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted. 1. Introduction Primary angle closure glaucoma (PACG) is a leading cause of bilateral blindness worldwide [1]. The disease is estimated to affect 16 million people, with 4 million bilaterally blind [2]. The chronic primary angle closure (CPAC) spectrum of disease ranges from primary angle closure suspects (PACS) to CPAC to chronic primary angle closure glaucoma (CPACG). PACS consist of eyes with anatomically narrow angles potentially predisposing to angle closure. Once closure has developed (as evidenced by elevated intraocular pressure (IOP), peripheral anterior synechia (PAS), trabecular pigment smudging, or other signs of true apposition of iris to trabecular meshwork),CPAC has occurred. Chronic primary angle closure glaucoma (CPACG) is diagnosed when, in addition to CPAC, glaucomatous optic neuropathy is present, as evidenced by visual field, nerve fiber layer, or optic nerve damage [3]. Treatment of the CPAC spectrum is directed toward 2 goals: (1) eliminate the mechanism of angle closure and (2) control any remaining IOP elevation. Peripheral iridotomy (PI) is currently the first line of treatment [4]. If PI does not improve angle anatomy, iridoplasty may be performed to open the angle, but this too may
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