Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes

Aung, Tin; Ang, Leonard P. K.; Chan, Siew‐Pang; Chew, Paul

doi:10.1016/s0002-9394(00)00621-8

Cited by 215 publications

(143 citation statements)

References 16 publications

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“…19 In contrast, a longer duration of raised IOP during APAC may result in the formation of peripheral anterior synechiae, subsequent IOP elevation despite a patent peripheral iridotomy, and optic disc cupping. 1,2,6,9 Our finding that peripapillary RNFL loss following APAC was associated with pale discs and visual field loss has not been previously reported. Previous studies have shown that an episode of APAC is associated with RNFL loss, detectable by both scanning laser polarimetry and OCT, [3][4][5] but the functional consequence of this is unclear.…”

Section: Discussionmentioning

confidence: 50%

“…Many studies report a poor long-term visual outcome after APAC, with high rates of blindness and glaucomatous optic neuropathy. 1,2 Retinal nerve fibre layer (RNFL) loss, [3][4][5] optic nerve head (ONH) damage, 6,7 and visual field defects [8][9][10] have been described following APAC. However, the severity of these sequelae is not well established, and little is known about the correlation between them.…”

Section: Introductionmentioning

confidence: 99%

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Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acute primary angle closure

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et al. 2011

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Aims/Purpose To determine and correlate the long-term changes in retinal nerve fibre layer (RNFL) thickness, optic nerve head (ONH) morphology, and visual fields after a single episode of acute primary angle closure (APAC). Methods This was a cross-sectional comparative study of patients at National University Hospital (Singapore) from 2000 to 2006 after an episode of unilateral APAC. The peripapillary and macular RNFL were measured using Stratus optical coherence tomography (OCT) and ONH configuration was assessed using Heidelberg Retina Tomography (HRT)-III. Humphrey perimetry was also performed, and the presence of disc pallor was noted. APAC eyes were compared with fellow eyes as matched controls. Results Twenty-five patients were assessed at a median of 33 months (range, 11-85 months) after APAC. OCT showed that there was a reduction in the peripapillary and outer macular RNFL thickness in APAC eyes compared with controls. Humphrey perimetry revealed significantly reduced mean deviation (P ¼ 0.006) and increased pattern standard deviation (P ¼ 0.045) in APAC eyes compared with controls. HRT-III showed no difference in mean rim area, rim volume, or cup-disc ratio between APAC eyes and controls. Disc pallor was present in nine APAC eyes (36%) but was absent in fellow eyes (P ¼ 0.002), and was associated with peripapillary RNFL thinning, visual field loss, and an increased interval between the onset of symptoms and normalization of intraocular pressure (P ¼ 0.023). Conclusion APAC results in peripapillary and outer macular RNFL loss, visual field defects, and optic disc pallor, even in cases in which the ONH configuration remains unchanged.

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Section: Discussionmentioning

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acute primary angle closure

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et al. 2011

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“…17,18 Following an episode of symptomatic angle closure, reports suggest that satisfactory IOP control can be achieved in 42-72% of cases with PI alone. 82,83 Once GON, defined as structural damage to the disc and a field defect, have developed, virtually all cases (94-100%) will require further treatment to control IOP. 84 Inferring that earlier intervention will definitely lead to a beneficial outcome in the long term is hindered by the phenomenon of 'lead-time bias'Fthe concept that earlier detection and treatment merely increase the period of followup, until the time when control of the disease is lost, with no change in outcome for the individual.…”

Section: Effect Of Pimentioning

confidence: 99%

Angle-closure glaucoma in East Asian and European people. Different diseases?

Foster

Johnson

et al. 2005

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In contrast to the pattern of disease in Europeans, primary angle closure has a higher prevalence and tends to be asymptomatic in East Asians. The higher prevalence is attributed to differences in anterior chamber and angle anatomy. Several studies suggest that central anterior chamber depth is shallower in East Asians than in Europeans, although this is not universally accepted. It is debated whether pupil block is the predominant mechanism of angle closure in Asian people. Meaningful comparison between studies is currently hindered by differences in patient selection, examination technique, and case definition; however, the major scientific deficiency is the paucity of prospective followup data to give an insight into natural history of the disease. This review examines the data on prevalence, risk factors, and mechanism of angle closure. Special consideration is given to limitations of methodology in research to date, with the intention of developing more robust data in future studies.

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“…Furthermore, a study on the long-term outcomes of APAC patients in Singapore found that the delay in presentation of more than 3 days was not a significant risk factor in later development of chronic IOP rise after the initial APAC episode. 9 Although it seems biologically plausible that rapid lowering of IOP after APAC should cause less optic nerve damage compared with a more gradual reduction, this has yet to be proven in clinical studies. Furthermore, the risk to ocular morbidity of such strategies is likely to be greater.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of medical therapy in the initial management of acute primary angle closure in Asians

Ramli

et al. 2010

Eye

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Purpose Recent studies have advocated the use of laser iridoplasty or paracentesis in the initial management of patients with acute primary angle closure (APAC). The aim of this study was to ascertain the effectiveness of medical treatment consisting of topical and systemic intraocular pressure (IOP)-lowering agents in the initial management of APAC. Methods This was an observational case series of consecutive patients presenting with APAC at a Singapore hospital over 2 years. On diagnosis, all subjects received intravenous acetazolamide followed by oral acetazolamide, topical pilocarpine, timolol, and steroid eye drops. Resolution of APAC was defined as IOP o21 mm Hg with no acute symptoms. Results In all, 134 consecutive APAC subjects were studied. The majority of subjects were Chinese (96.3%) and female (80%), and the mean age was 63.7 ± 9.6 years. The mean presenting IOP was 58 ± 12.7 mm Hg and mean duration of symptoms was 2.8 ± 3.2 days. With medical therapy, APAC attacks resolved within 3, 6, 12, and 24 h in 28 (21.5%), 58 (44.6%), 99 (76.2%), and 116 (89.2%) subjects, respectively. After resolution of APAC, laser iridotomy was performed in 81.6% of the subjects; 16.2% of the subjects underwent cataract extraction. There was failure of resolution of APAC in only 3 subjects (2.2%). No subject suffered any serious side effects as a result of treatment. Conclusions Medical therapy resulted in resolution of APAC within 12 h in 76.2% of the subjects and within 24 h in 89.2% of the subjects, showing the effectiveness of medical therapy in the initial management of APAC.

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Acute primary angle-closure: long-term intraocular pressure outcome in Asian eyes

Cited by 215 publications

References 16 publications

Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acute primary angle closure

Changes in retinal nerve fibre layer, optic nerve head morphology, and visual field after acute primary angle closure

Angle-closure glaucoma in East Asian and European people. Different diseases?

Efficacy of medical therapy in the initial management of acute primary angle closure in Asians

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