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KMID : 1813520210100020037
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Journal of the Korean Glaucoma Society
2021 Volume.10 No. 2 p.37 ~ p.46
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Natural Course of Acute Primary Angle Closure without Subsequent Medical Treatment after Surgical Resolution of an Acute Episode
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Kwak Ji-Yoon
Lee Eun-Ji
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Abstract
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Purpose : To investigate the natural course of acute primary angle closure (APAC) in eyes that did not receive intraocular pressure (IOP)-lowering medication after the surgical resolution of an acute episode.
Methods : Patients with APAC who had undergone surgical treatment with laser iridotomy and/or cataract operation and had been followed-up for more than 2 years were included. Patients were classified depending on whether or not they received topical IOP-lowering medications after surgery. Clinical characteristics and the rate of global retinal nerve fiber layer (RNFL) thinning were compared in the two groups. Factors associated with the rate of RNFL thinning in the untreated group were determined using linear regression analysis.
Results : The study included 61 eyes of 57 patients; of these 61 eyes, 26 received medical IOP-lowering treatment after primary surgical intervention (treated group), and 35 did not (untreated group). The untreated group had higher IOP at the time of an acute episode (p = 0.045), smaller IOP fluctuations during follow-up (p = 0.008), shorter axial length (p = 0.049), shorter duration of symptom (p = 0.002) and larger baseline global RNFL thickness (p < 0.001) than the treated group. The rate of global RNFL thinning was significantly slower in the untreated than in the treated group (p = 0.002). Multivariate analysis showed that larger IOP fluctuation (β = -0.843, p = 0.010) and thicker baseline global RNFL (β = -0.022, p = 0.034) were associated with a faster rate of global RNFL thinning in the untreated group.
Conclusions : The rate of RNFL thinning after surgery for APAC was not faster in eyes that did not receive subsequent medical treatment than in eyes that received IOP-lowering medications. Larger fluctuations of IOP during follow-up and a thicker baseline global RNFL layer were associated with a faster rate of global RNFL thinning in APAC eyes without medical treatment.
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KEYWORD
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Angle-closure glaucoma, Disease progression
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