Abstract
PurposeTo investigate the changes in the demographic, clinical, and biometric characteristics of APAC patients in South Korea during the last decade.MethodsMedical records of patients with APAC who visit the emergency department or the glaucoma clinic of Chonnam National University Hospital, a tertiary referral center in Gwangju, South Korea in 2007 and 2017 were analyzed. Demographics, clinical characteristics, and treatment modality were compared between the APAC patients in 2007 and 2017.ResultsThe number of patients with APAC increased from 54 in 2007 to 68 in 2017. Female patients in their 60s were most common in both groups and there was no significant difference in IOP, cataract grade, gonioscopic grading, PAS, or optic nerve damage between the two groups at baseline visit (all P > 0.05). However, APAC eyes in 2017 had a shallower ACD (1.74 ± 0.28 mm vs 1.87 ± 0.35 mm; P = 0.024) and greater LV (1.05 ± 0.26 mm vs 0.93 ± 0.19 mm; P = 0.001) than those of APAC eyes in 2007. During one year follow-up, 25 patients (51.02%) received LPI only, and 18 patients (36.73%) required LE, and 6 patients (12.24%) required phacotrabeculectomy or sequential LE and trabeculectomy. However, in 2017, LPI alone was sufficient in 23 patients (38.33%), 29 patients (48.33%) required further LE, and 8 patients (13.33%) required phacotrabeculectomy or sequential LE and trabeculectomy for the treatment of APAC (P = 0.015).ConclusionsCompared to older cases of APAC, recent cases received LE more frequently, which suggests an increasing trend of LE as a treatment option for APAC. In addition, recent cases had a greater LV and shallower ACD than older cases and these biometric differences may be one of the reasons for increasing rate of LE in this study.
Highlights
Primary angle closure disease (PACD) is one of the leading causes of blindness worldwide and predominantly affects Asian populations [1,2]
The number of patients with Acute primary angle closure (APAC) increased from 54 in 2007 to 68 in 2017. Female patients in their 60s were most common in both groups and there was no significant difference in intraocular pressure (IOP), cataract grade, gonioscopic grading, peripheral anterior synechia (PAS), or optic nerve damage between the two groups at baseline visit
In 2017, laser peripheral iridotomy (LPI) alone was sufficient in 23 patients (38.33%), 29 patients (48.33%) required further Lens extraction (LE), and 8 patients (13.33%) required phacotrabeculectomy or sequential LE and trabeculectomy for the treatment of APAC (P = 0.015)
Summary
Primary angle closure disease (PACD) is one of the leading causes of blindness worldwide and predominantly affects Asian populations [1,2]. Eyes with PACD are characterized by a crowded anterior segment and appositional or synechial closure of the angle. Acute primary angle closure (APAC) is a subtype of PACD and an ocular emergency that requires immediate reduction of the elevated intraocular pressure (IOP) to prevent permanent vision loss. Owing to anterior segment optical coherence tomography (AS-OCT), high-resolution crosssectional images of the anterior segment can be obtained. These objective and reproducible techniques enable APAC to be sub-classified based on the principal mechanism of the disease. Ng et al [4] suggested that APAC can be classified into four different mechanisms, including pupillary block (PB), plateau iris syndrome, lens disproportion, and ciliary block
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