What is the role of surgery in the management of PACG?

In the management of primary angle-closure glaucoma (PACG), the primary role of surgery is to relieve pupillary block. PACG occurs when the peripheral iris obstructs the trabecular meshwork, leading to increased intraocular pressure due to an inability of the aqueous humor to escape. This blockage can cause significant pressure buildup, which may lead to optic nerve damage and potentially permanent vision loss.

Performing surgery, particularly procedures like laser peripheral iridotomy, creates a new drainage pathway for aqueous humor by making a small hole in the peripheral iris. This helps to relieve the pressure by bypassing the obstructed area, thus reducing the risk of damage to the optic nerve and preserving vision.

The other potential responses do not accurately represent the primary surgical aim in PACG management. For instance, while surgery may sometimes help manage complications associated with cataract formation, its main intention is not to reduce the risk of cataracts specifically. Additionally, surgery does not aim to permanently cure PACG because it may require ongoing medical management post-surgery. Lastly, closing the anterior chamber angle is contrary to optimal surgical intervention, as open access is necessary for drainage and pressure relief.