Correct Answer:

B) Primary Open-Angle Glaucoma (POAG)

Clinical Explanation & Rationalization:

The diagnosis of Primary Open-Angle Glaucoma is established by the presence of three key criteria in this case:

• Elevated Intraocular Pressure: The readings of 24/26 \text{ mmHg} are consistently above the traditional threshold of 21 \text{ mmHg}, ruling out Normal-Tension Glaucoma (NTG).
• Open Drainage Angles: Gonioscopy confirmed Grade 4 Shaffer angles with no evidence of obstruction or peripheral anterior synechiae (PAS), ruling out angle-closure variants.
• Glaucomatous Optic Neuropathy: The funduscopic findings are definitive for damage. Specifically:
• Vertical Elongation (CDR 0.7/0.8): Indicates loss of neuroretinal rim tissue at the poles.
• Drance Haemorrhage: A splinter haemorrhage at the disc margin is a pathognomonic sign of active glaucomatous progression.
• Nasalization of Vessels: A classic sign of advanced cupping where the retinal vessels are pushed toward the nasal side of the disc as the cup expands.