Longitudinal changes of angle configuration in primary angle-closure suspects: the Zhongshan Angle-Closure Prevention Trial.
OBJECTIVE
To determine longitudinal changes in angle configuration in the eyes of primary angle-closure suspects (PACS) treated by laser peripheral iridotomy (LPI) and in untreated fellow eyes.


METHODS
Longitudinal cohort study.


METHODS
Primary angle-closure suspects aged 50 to 70 years were enrolled in a randomized, controlled clinical trial.


METHODS
Each participant was treated by LPI in 1 randomly selected eye, with the fellow eye serving as a control. Angle width was assessed in a masked fashion using gonioscopy and anterior segment optical coherence tomography (AS-OCT) before and at 2 weeks, 6 months, and 18 months after LPI.


METHODS
Angle width in degrees was calculated from Shaffer grades assessed under static gonioscopy. Angle configuration was also evaluated using angle opening distance (AOD250, AOD500, AOD750), trabecular-iris space area (TISA500, TISA750), and angle recess area (ARA) measured in AS-OCT images.


RESULTS
No significant difference was found in baseline measures of angle configuration between treated and untreated eyes. At 2 weeks after LPI, the drainage angle on gonioscopy widened from a mean of 13.5° at baseline to a mean of 25.7° in treated eyes, which was also confirmed by significant increases in all AS-OCT angle width measures (P<0.001 for all variables). Between 2 weeks and 18 months after LPI, a significant decrease in angle width was observed over time in treated eyes (P<0.001 for all variables), although the change over the first 5.5 months was not statistically significant for angle width measured under gonioscopy (P = 0.18), AOD250 (P = 0.167) and ARA (P = 0.83). In untreated eyes, angle width consistently decreased across all follow-up visits after LPI, with a more rapid longitudinal decrease compared with treated eyes (P values for all variables ≤0.003). The annual rate of change in angle width was equivalent to 1.2°/year (95% confidence interval [CI], 0.8-1.6) in treated eyes and 1.6°/year (95% CI, 1.3-2.0) in untreated eyes (P<0.001).


CONCLUSIONS
Angle width of treated eyes increased markedly after LPI, remained stable for 6 months, and then decreased significantly by 18 months after LPI. Untreated eyes experienced a more consistent and rapid decrease in angle width over the same time period.
UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, United Kingdom.|State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Yuzhen
Y
Jiang
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.|Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland.
Dolly S
DS
Chang
UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, United Kingdom.
Haogang
H
Zhu
Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.
Anthony P
AP
Khawaja
Singapore Eye Research Institute, Singapore National Eye Center, Singapore and National University of Singapore, Singapore.
Tin
T
Aung
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Shengsong
S
Huang
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Qianyun
Q
Chen
Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland.
Beatriz
B
Munoz
UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, United Kingdom.
Carlota M
CM
Grossi
UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, United Kingdom.|State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
Mingguang
M
He
State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.|Wilmer Eye Institute, Dana Center for Preventive Ophthalmology, Johns Hopkins University, Baltimore, Maryland.|Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
David S
DS
Friedman
UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, United Kingdom.|State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.|NIHR Biomedical Research Centre at Moorfields Eye Hospital, London, United Kingdom.
Paul J
PJ
Foster
D000368:Aged; D000869:Anterior Eye Segment / Q000473:pathology; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000473:pathology* / Q000517:prevention & control / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D032801:Iridectomy / Q000379:methods*; D053685:Laser Therapy / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D041623:Tomography, Optical Coherence