Medical treatment

Acute primary angle closure resolved after medical treatment in a quarter of eyes, study finds

A retrospective study found that 26% of eyes with acute primary angle closure (APAC) resolved after initial medical treatment.

A study published in the Journal of Ophthalmology found that 26% of eyes with acute primary angle closure (APAC) saw improvement after initial treatment, 33% of eyes requiring laser iridotomy (LI), and 40% of eyes requiring lentectomy.

APAC is an ophthalmic condition that requires emergency treatment, first with topical therapies, then with surgery if necessary, to resolve the increased intraocular pressure (IOP) resulting from the acute attack.

This study used 87 eyes of 87 patients (17 males and 80 females) with a mean age (SD) of 69.0 (9.0) years. All patients developed ACPA between January 2006 and June 2020 at Kitasato University Hospital. All patients had to complete at least a 3-month follow-up to be included.

Patients who had a history of eye surgery, eye trauma, or other concurrent eye diseases outside of glaucoma were excluded from the study. A single eye was randomly selected from each patient for analysis if bilateral APAC had occurred.

All eyes received topical administration of 2% pilocarpine and systemic mannitol. Surgical treatment was performed after that if the APAC was unresolved on first treatment, and all patients who needed surgery were separated into LI and lensectomy groups. Best spectacle corrected visual acuity (BSCVA), selected treatment method, IOP, and corneal endothelial cell (ECD) density were all measured at final follow-up.

The mean (SD) pretreated IOP in the study population was 56.4 (9.0) mm Hg (95% CI, 38.7-74.1 mm Hg). Patients elapsed on average (SD) 1.6 (2.7) days between the onset of subjective symptoms and the medical examination. The mean (SD) follow-up period was 15.5 (19.3) months.

Of the 87 eyes with APAC, 23 eyes (26%) resolved after initial treatment. There were 29 eyes (33%) that were treated by LI and 35 eyes (40%) that were treated by lentectomy. The mean (SD) BSCVA of the study population was 0.09 (0.43) logMAR, the mean (SD) IOP was 12.6 (2.8) mm Hg, and the mean ECD was 2200.00 (644.7) cells/mm2 at last follow-up.

IOL implantation was performed simultaneously in 17 of 35 eyes (49%) after lensectomy, 15 of which underwent in-bag fixation. Intraocular lens implantation was also performed secondarily in 17 of the remaining 18 eyes, with only 1 eye remaining aphakic (without lens). Bullous keratopathy developed in 1 eye after LI, and glaucoma surgery was required in 7 eyes (8%).

There were no significant differences in BSCVA, IOP, or ECD between treatment groups.

There were some limitations to this study. It did not assess ECD in all eyes, and the follow-up time and observation period were relatively short. The etiology of ACPA has not been confirmed due to the lack of images using anterior segment optical coherence tomography or ultrasound biomicroscopy. The study was conducted retrospectively without a control group, so a prospective controlled study in a larger cohort would confirm these results.

The researchers concluded that their study demonstrated that just over a quarter of eyes with APAC resolved after initial medical treatment. The remaining patients were helped with LI and lensectomy after initial medical treatment.

“We believe this information will be clinically useful in understanding the overall prognosis of post-APAC patients,” the authors wrote.

Reference

Iijima K, Kamiya K, Iida Y, Shoji N. Comparison of outcomes of laser iridotomy and lensectomy for acute primary angle closure. J Ophthalmol. Published online May 30, 2022. doi:10.1155/2022/6959479