Long-term outcomes in asians after acute primary angle closure.
OBJECTIVE
To determine the long-term outcome of Asian eyes with an acute attack of primary angle closure (APAC) and to identify risk factors at presentation associated with the development of glaucomatous optic nerve damage.


METHODS
Cross-sectional observational case series.


METHODS
Ninety individuals who were initially seen with APAC 4 to 10 years previously at 2 Singapore hospitals.


METHODS
All subjects underwent a complete eye examination, including visual acuity, visual field testing, dilated eye examination, and optic nerve head photography. The optic discs were judged clinically and photographically as to whether there was glaucomatous optic neuropathy present, and visual fields were assessed for corresponding visual field loss. All visual fields and optic nerve photographs underwent a second evaluation by an experienced, but masked, glaucoma specialist, who assessed whether the changes were compatible with glaucoma.


METHODS
The main outcome measures were blindness (defined as best-corrected visual acuity worse than 6/60 and/or central visual field of less than 20 degrees in the attack eye) and glaucomatous optic neuropathy (GON).


RESULTS
A total of 90 of 170 eligible subjects (65.2%) were examined. All subjects were Asian and were predominantly Chinese (78 subjects [86.7%]). There were 61 females (67.8%), and the age of the subjects was 62.0+/-9.0 years (mean +/- standard deviation) at the time of APAC, with a mean duration of 6.3+/-1.5 years from the time of the APAC episode to the study examination. Sixteen (17.8%) subjects were blind in the attack eye; half of the cases of blindness were caused by glaucoma. Forty-three subjects (47.8%) had GON, with 13 eyes (15.5%) having markedly cupped optic discs (cup-to-disc ratio >0.9). Thirty-eight eyes (58%) had best-corrected vision worse than 6/9, with cataract responsible for close to half the cases of poor vision. There were no identifiable risk factors related to the APAC episode that were significantly associated with the presence of GON.


CONCLUSIONS
Several years after being seen with APAC, 17.8% of subjects examined were blind in the attack eye, and almost half had glaucomatous optic nerve damage. Vision was also reduced in a large number of individuals, largely from unoperated cataract. Subjects with APAC would benefit from regular follow-up to monitor for visual field decline and glaucoma development.
Glaucoma Department, Singapore National Eye Center, and National University of Singapore. tin11@pacific.net.sg
Tin
T
Aung
David S
DS
Friedman
Paul T K
PT
Chew
Leonard P
LP
Ang
Gus
G
Gazzard
Yoke-Fong
YF
Lai
Leonard
L
Yip
Hong
H
Lai
Harry
H
Quigley
Steve K L
SK
Seah
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001208:Asia / Q000453:epidemiology; D001766:Blindness / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000150:complications* / Q000208:ethnology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009898:Optic Disk / Q000473:pathology; D009901:Optic Nerve Diseases / Q000209:etiology*; D011379:Prognosis; D012307:Risk Factors; D014792:Visual Acuity; D014794:Visual Fields