Outcomes following acute primary angle closure in an Asian population

• Published in: Clinical & experimental ophthalmology Vol. 37; no. 5; pp. 467 - 472
• Main Authors: Tan, Anna M, Loon, Seng C, Chew, Paul T K
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.07.2009
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; angle closure; Antihypertensive Agents - therapeutic use; Asian Continental Ancestry Group - ethnology; Cataract Extraction; Female; Follow-Up Studies; glaucoma; Glaucoma, Angle-Closure - ethnology; Glaucoma, Angle-Closure - physiopathology; Glaucoma, Angle-Closure - therapy; Humans; Intraocular Pressure - physiology; Iridectomy - methods; Iris - surgery; laser peripheral iridotomy; Laser Therapy; Male; Middle Aged; Outcome Assessment (Health Care); Retrospective Studies; Risk Factors; Singapore - epidemiology; Tonometry, Ocular; Visual Acuity - physiology; Singapore
• ISSN: 1442-6404; 1442-9071
• DOI: 10.1111/j.1442-9071.2009.02060.x

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.