Outcomes following acute primary angle closure in an Asian population

Clin Exp Ophthalmol. 2009 Jul;37(5):467-72. doi: 10.1111/j.1442-9071.2009.02060.x.

Abstract

Background: Data regarding development of primary angle closure glaucoma (PACG) following acute primary angle closure (APAC) is conflicting. This study looks at outcomes after an APAC episode with a secondary aim to identify any risk factors that could predict progression to PACG.

Methods: This is a retrospective review of the charts of consecutive patients who were diagnosed with APAC from December 2003 to June 2006. All were treated in a standard manner with initial intensive medical therapy or laser iridoplasty followed by early laser peripheral iridotomy within 24 h of presentation.

Results: Forty-two eyes of 41 patients were analysed. The mean follow-up period was 27.3 +/- 16.2 months. Nine eyes (21.4%) developed an increase in intraocular pressure (IOP) within a mean of 11.9 months (median 5 months) after resolution of APAC. Eight eyes went on to have trabeculectomy or glaucoma drainage device. At final follow up, the mean IOP of attack eye was 13.3 +/- 2.92 mmHg. None of the eyes, including those that underwent surgery, required topical medication to control IOP. Thirty-eight eyes (90.5%) have BCVA of 6/6 to 6/12. The duration of symptoms before presentation (P = 0.00) and duration taken to abort the acute attack (P = 0.01) were found to be significantly associated with development of PACG.

Conclusion: The results of this study suggest that outcomes following successful treatment of APAC may not be as poor as described previously. Early aggressive management of the acute episode may have a role to play in preventing development of PACG after APAC.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Antihypertensive Agents / therapeutic use
  • Asian People / ethnology*
  • Cataract Extraction
  • Female
  • Follow-Up Studies
  • Glaucoma, Angle-Closure / ethnology
  • Glaucoma, Angle-Closure / physiopathology*
  • Glaucoma, Angle-Closure / therapy*
  • Humans
  • Intraocular Pressure / physiology*
  • Iridectomy / methods
  • Iris / surgery
  • Laser Therapy
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Risk Factors
  • Singapore / epidemiology
  • Tonometry, Ocular
  • Visual Acuity / physiology*

Substances

  • Antihypertensive Agents