Comparative analysis between early and late onset primary angle closure glaucoma

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AbstractObjective: This prospective observational pilot study aimed at comparing the aetiology and clinical profile of early onset primary angle closure glaucoma (EPACG) with late onset primary angle closure glaucoma (LPACG).Methods: The early (18–40 year) and late (≥50 year) onset PACG patients without any surgical intervention or any other pathology (leading to secondary angle closure) were enrolled. One eye of each patient was considered for analysis. Clinico‐demographic details of the patients were noted. Anterior segment optical tomography (CASIA2, Tomey Corporation, Japan), Ultrasound biomicroscopy (Vumax, Sonomed, NY) were performed to identify the etiopathogenesis among two groups.Results: Mean age of participants was 32.8 ± 7.8 years EPACG (n = 45) and 55.83 ± 6.7 years in the LPACG group (n = 31). Relative pupillary block (90.32%, n = 28) was the commonest mechanism of angle closure in LPACG while non pupillary block [66.67%, n = 31, pseudoplateau iris‐ 44.44% (n = 20), plateau iris‐24.44% (n = 11)] was the commonest mechanism in EPACG group. The EPACG had significantly shorter axial length (22.1 ± 1.1 vs 22.93 ± 1; p = 0.003), thinner lens (4.35 ± 0.3 vs. 4.6 ± 0.2; p = 0.01), more anterior relative lens position (0.19 ± 0.01 vs. 0.2 ± 0.01; p = 0.007), lesser anterior chamber depth (2.1 ± 0.3 vs. 2.3 ± 0.32; p = 0.01) and lesser anterior chamber area (15 ± 3.3 vs. 16.7 ± 3.4; p = 0.04) compared to LPACG. EPACG had greater lens vault (0.79 ± 0.4 vs. 0.61 ± 0.2; p = 0.01) compared to LPACG. Among the EPACG, 15.55%, (n = 7, vs. none in LPACG) had nanophthalmos. The BCVA was worse in EPACG (0.2 (range 0–2) vs. 0.6 (0–2) logMAR in LPACG) despite refractive error being more emmetropic vs LPACG.Conclusions: Non pupillary block mechanisms are more common in EPACG as compared to LPACG. Despite thinner lens, early onset group has greater lens vault and shorter axial length contributing to greater angle crowding and present with greater visual morbidity.