Long-term outcomes after acute primary angle closure in a White Caucasian population.
BACKGROUND
Very limited data is available on the morbidity and progression to primary angle closure glaucoma (PACG) in White Caucasian individuals following acute primary angle closure (APAC). Our aim is to identify the number of eyes who developed PACG following an APAC attack and to determine the risk factors for PACG development in a White Caucasian population in the United Kingdom (UK). We assessed the rate of blindness and visual impairment in the affected eye as defined by the World Health Organisation.


METHODS
Retrospective observational study including 48 consecutive eyes of 46 White Caucasian subjects who presented with APAC to a tertiary referral unit in the United Kingdom. Eyes affected by glaucomatous optic neuropathy at presentation were excluded. We included in our analysis socio-demographic variables, ophthalmic findings, investigations and treatment.


RESULTS
The mean final follow up period was 27 months ± 14 standard deviation (SD). Seven (15 %) eyes developed PACG. Statistical analysis showed that the following factors were linked to a higher risk of progression: length of symptoms before presentation and time taken to break the attack. The intraocular pressure (IOP) was significantly higher in the group who developed PACG at the one- and six-month visit compared to the group which did not develop the disease. At the final visit 3 (6 %) eyes were blind while 5 (10 %) were visually impaired. PACG was responsible for visual impairment in 2 (4 %) eyes but not for any case of blindness.


CONCLUSIONS
Delayed presentation, length of time taken to break the attack and poor IOP control can result in PACG development and visual impairment. APAC causes a low long-term visual morbidity in White Caucasians.
Birmingham & Midland Eye Centre, Glaucoma Services, Birmingham, UK. andreattawalter@hotmail.com.|University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. andreattawalter@hotmail.com.|Queen Elizabeth Hospital, Birmingham, B15 2TH, UK. andreattawalter@hotmail.com.
Walter
W
Andreatta
Birmingham & Midland Eye Centre, Glaucoma Services, Birmingham, UK. i_melaroud@hotmail.com.
Ibrahim
I
Elaroud
Wellcome Trust Clinical Research Facility, Queen Elizabeth Hospital, Birmingham, UK. peter.nightingale@uhb.nhs.uk.
Peter
P
Nightingale
Birmingham & Midland Eye Centre, Glaucoma Services, Birmingham, UK. maged.nessim@nhs.net.|Honorary Senior Clinical Lecturer, University of Birmingham, Birmingham, UK. maged.nessim@nhs.net.
Maged
M
Nessim
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D015812:Glaucoma, Angle-Closure / Q000175:diagnosis* / Q000208:ethnology*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014065:Tonometry, Ocular; D006113:United Kingdom / Q000453:epidemiology; D014792:Visual Acuity; D014794:Visual Fields; D044465:White People / Q000208:ethnology*