title: Acute primary angle closure attack does not cause an increased cup-to-disc ratio.
abstract: OBJECTIVE
  To determine if an increased cup-to-disc ratio (CDR) and retinal nerve fiber layer (RNFL) loss occur after acute primary angle closure (APAC).
  
  
  METHODS
  Prospective, observational case series.
  
  
  METHODS
  Twenty participants with unilateral APAC provided 20 affected eyes and 20 fellow eyes (controls) for analysis.
  
  
  METHODS
  After initial presentation, participants attended 3 further assessments over a 12-month period (visit 2, within 2 weeks; visit 3, 2-3 months; and visit 4, 6-12 months), in which they underwent the following investigations: Heidelberg Retinal Tomography (Heidelberg Engineering, Dossenheim, Germany), optical coherence tomography of the RNFL and macula, and automated perimetry.
  
  
  METHODS
  Cup-to-disc ratio, optic cup area, neuroretinal rim area, RNFL thickness, macular thickness, and volume.
  
  
  RESULTS
  There was no change from visits 2 to 4 in CDR (0.46 ± 0.17 vs. 0.47 ± 0.20; P = 0.94), neuroretinal rim area (1.64 ± 0.55 vs. 1.64 ± 0.57; P = 0.96), or other optic nerve head parameters analyzed in eyes with APAC. The mean overall RNFL thickness decreased from 106.6 ± 17.9 μm to 92.9 ± 18.3 μm between visits 2 and 3 (P<0.01) in affected eyes. The superior quadrant RNFL thickness decreased from 134.8 ± 25.9 μm to 113 ± 25.7 μm (P<0.01), and the inferior quadrant RNFL thickness decreased from 139.1 ± 28.4 μm to 115.6 ± 24.9 μm (P<0.01). There was no significant change in macular thickness or volume.
  
  
  CONCLUSIONS
  This study demonstrated that an increase in CDR does not occur after APAC that is treated promptly, although RNFL loss does occur.
authors.affiliation: Department of Ophthalmology, University of Auckland, Auckland, New Zealand.
authors.forename: Shenton S L
authors.initials: SS
authors.lastname: Chew
authors.forename: Sushil
authors.initials: S
authors.lastname: Vasudevan
authors.forename: Hussain Y
authors.initials: HY
authors.lastname: Patel
authors.forename: Lulu U
authors.initials: LU
authors.lastname: Gurria
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Kerr
authors.forename: Greg
authors.initials: G
authors.lastname: Gamble
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Crowston
authors.forename: Helen V
authors.initials: HV
authors.lastname: Danesh-Meyer
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007429:Intraocular Pressure; D008266:Macula Lutea / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D009901:Optic Nerve Diseases / Q000175:diagnosis; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D058609:Visual Field Tests; D014794:Visual Fields