Acute Primary Angle-closure Glaucoma Research Articles

Early histopathologic changes in the retina and optic nerve in canine primary angle‐closure glaucoma

To characterize the morphology of canine globes enucleated 1-5days after the onset of overt clinical disease recognized by the owner. Paraffin-embedded globes from 47 dogs with acute primary angle-closure glaucoma (PACG) and 10 control dogs free of ocular disease were sectioned in the vertical plane sampling the optic nerve. Hematoxylin and eosin (H&E)-stained sections were used to count ganglion cell numbers. Terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was used to quantify cell death, and MHCII immunohistochemistry was used to evaluate for antigen-presenting phagocytes in a smaller subset of cases. MHCII-labeled phagocytes were present in the optic nerve and retina within the first 24h of documented glaucoma suggesting an early up-regulation. Globes removed within 1day of overt clinical disease had a mild neutrophilic infiltrate in the retina and optic nerve as well as marked ganglion cell necrosis. By 5days after clinical signs appear, there is a rapid decline in the number of ganglion cells and cell death detected by TUNEL labeling in the outer and inner nuclear layers of the retina, but not the ganglion cell layer. The neuropil of the optic nerve progresses from edema and neutrophilia to malacia. These findings suggest that retinal and optic nerve degeneration in dogs with PACG progresses rapidly to irreversible tissue loss within days of recognizable clinical disease.

The causes and preventive measures of misdiagnosis on primary acute angle closure glaucoma

Objective To explore the causes and preventive measures for misdiagnosed primary acute angle closure glaucoma(PAACG).Methods In this retrospective analyses,the causes of 38 cases of misdiagnosed PAACG were analyzed who first visited other departments and were diagnosed as other diseases.The preventive measures of misdiagnosis were concluded.Results Of 38 cases,misdiagnoses included hypertensive encephalopathy in 13 cases,lacunar infarction in 11 cases,migraine in 5 cases,nerveous headache in 7 cases and gastrointestinal diseases in 2 cases.All cases were transferred to ophthalmology department after consultation and underwent antiglaucoma surgeries.After treatment,the patients' visual acuities were at non-light perception in 4 eyes,light perception in 3 eyes,counting fingers in 7 eyes,O.05 ～0.08 in 8 eyes,0.1 ～ 0.2 in 11 eyes and 0.3 ～ 0.5 in 5 eyes.The longer misdiagnoses lasted,the severer visual impairment became.Conclusion PAACG without systemic symptoms and first visit other department except ophthalmology department will easily to be misdiagnosed.To avoid misdiagnosis,it is glaucoma specialist' s responsibility to promote PAACG education for doctors and patients. Key words: Glaucoma, primary, angle closure, acute; Misdiagnosis

Genotype–phenotype analysis of SNPs associated with primary angle closure glaucoma (rs1015213, rs3753841 and rs11024102) and ocular biometry in the EPIC-Norfolk Eye Study

AimsTo investigate if the single nucleotide polymorphisms rs3753841, rs1015213 and rs11024102, recently implicated in the development of acute primary angle closure or primary angle closure glaucoma, are associated with ocular...

Comparative study on plateau iris between different subtypes of primary angle closure glaucoma after laser peripheral iridotomy

Objective To compare the prevalence of plateau iris in acute primary angle closure glaucoma (APACG) and chronic angle closure glaucoma (CACG) after laser peripheral iridotomy.Methods 37 cases (37 eyes) with APACG and 29 cases (29 eyes) with CACG were enrolled in the study.In APACG group,the fellow eyes of the eyes with acute attack were studied.In CACG group,eyes with less than 90° PAS were studied.UBM was used for all cases at one month after laser peripheral iridotomy and stopping pilocarpine eyedrops more than one week.Platau iris in a quadrant was defined by anteriorly directed ciliary body,absent ciliary sulcus,steep iris root from its point of insertion followed by a downward angulation,flat iris plane,and irido-angle contact.At least two quadrants had to fulfill these UBM criteria for an eye to be classified as having platau iris.Results 12 of 29 (41.4％) cases in CACG group fulfilled all the criteria for platau iris,while in APACG group,7 of 37 (18.9％) cases were diagnosed as platau iris.The difference was statistically significant (P =0.045) after laser peripheral iridotomy.Conclusion Platau iris has a higher prevalence in CACG than in APACG after laser peripheral iridotomy. Key words: Glacoma, angle closure, primary; Platau iris

Evaluation of Secondary Glaucoma Associated With Subluxated Lens Misdiagnosed as Acute Primary Angle-closure Glaucoma

To evaluate the causes of misdiagnosis in patients with acute angle-closure glaucoma secondary to subluxated lens, and postoperative outcomes. Retrospective clinical study. Five hundred twenty-six cases of acute angle-closure glaucoma were consecutively recruited from Zhongshan Ophthalmic Center between March 2003 and March 2009. Zonular dialysis, anterior chamber angle, and anterior chamber depth were examined by ultrasound biomicroscopy. Surgical therapy was performed according to the degree of zonular dialysis and angle closure. Thirty-one eyes (5.89%) with acute angle-closure glaucoma secondary to lens subluxation were misdiagnosed as acute primary angle-closure glaucoma. In these cases, the anterior chamber depth of the affected eyes was significantly shallower than the fellow eyes (1.34±0.45 vs. 2.27±0.44, P<0.05). The best-corrected visual acuity was significantly improved 3 months after surgery, and intraocular pressure was well controlled in all eyes. Mean intraocular pressure was 12.09±4.41 mm Hg without any medication at the final visit. The causes of misdiagnosis in patients with acute angle-closure glaucoma secondary to subluxated lens include neglected history and/or signs of ocular trauma. Lens extraction surgery was an effective therapy for these cases.

Determination of anterior segment changes with Pentacam after phacoemulsification in eyes with primary angle‐closure glaucoma

To investigate changes of anterior segment morphology in primary angle-closure glaucoma after phacoemulsification using the Pentacam system. Prospective, interventional study, Zhongshan Hospital of Sun Yat-sen University. Eighty-five eyes from 60 patients with primary angle-closure glaucoma undergoing phacoemulsification. Intraocular pressure was measured by Goldmann applanation tonometry. Anterior segment morphology was assessed using the Pentacam camera. The intraocular pressure, central anterior chamber depth, peripheral anterior chamber depth, anterior chamber volume, pupil diameter and anterior chamber angle preoperative and 3 months postoperative. A total 78 eyes of 55 patients with primary angle-closure glaucoma were included in the analysis. Thirty-two eyes (41.0%) had acute primary angle-closure glaucoma, and 46 eyes (59.0%) had chronic primary angle-closure glaucoma. In both groups, statistically significant decreases in intraocular pressure and increases in anterior chamber volume, central anterior chamber depth, peripheral anterior chamber depth and anterior chamber angle inferiorly, nasally, temporally and superiorly were observed at 3 months after phacoemulsification (all P < 0.001). Phacoemulsification induces significant changes in anterior segment morphology in primary angle-closure glaucoma accompanied by a significant fall in intraocular pressure in the short term.

Change of vascular endothelial progenitor cell in acute angle-closure glaucomatous patient

Background The circulating endothelial progenitor cells (EPCs)play an important role in postnatal vasculogenesis and restoration of endothelial injury.Previous investigation illustrated that a reduced ocular blood flow and vascular dysfunction caused by endothelial dysfunction plays a role in the pathogenesis of glaucoma.However,endothelial system accommodation is accomplished with the circulating EPCs. Objective The present trail was to investigate EPCs change in patients with primary acute angle-closure glaucoma (PACG)and explore the role of EPCs in the pathogenesis of PACG. Methods A prospective cohort study was designed.Thirty patients with PACG were enrolled in Tianjin Medical University General Hospital as PACG group,and 20 normal subjects served as control group.Periphery blood samples were obtained from all the patients and then stained with saturating concentrations of monoclonal antibodies,FITC-conjugated anti-CD34 and CD133 mAb.EPCs identified by CD34,CD133 were enumerated by flow cytometry,and the correlation between EPCs change and its relative factors was analyzed.Informed consent was obtained from each subject before any medical procedure. Results No significant differences were found in age,gender,vascular-related risk factor,blood biochemical indicators between PACG group and normal contol group(P＞0.05 ),but a higher intraocular pressure( IOP)was displayed in PACG group compared with normal control group ( P =0.00 ).The numbers of EPCs were ( 48 ± 22 ) cells/ml in PACG group and ( 65 ± 20 )cells/ml in normal control group with a significant difference between them (P=0.004).In PACG group,the numbers of EPCs were(60± 19 )cells/ml and (34 ±7 )cells/ml respeetively in phase 1 and phase 3 of optical nerve damage (Z=-3.015,P=0.002 ).There was a negative correlation between EPCs numbers and baseline IOP within a certain range( r=-0.835,P＜0.05 ).However,no obvious correlations were seen between EPCs numbers and blood lipid Level,blood glucose level or glaucoma course ( r =0.343,P =0.227 ; r =-0.203,P =0.419 ; r =0.198,P =0.610 ).The EPCs numbers in PACG patients with cardiovascular disease were(56±22)cells/ml and that of without PACG were (35± 15 ) cells/ml( P =0.005 ). Conclusions The numbers of EPCs decrease in PACG patient.These results imply that EPCs might play role during the restore of the optical nerve damage in PACG eye. Key words: Endothelial progenitor cell; Acute angle-closure glaucoma; Flow cytometry

Lens dislocation has a possible relationship with laser iridotomy

We report our recent experience of four eyes with spontaneous lens dislocation in four patients with no history of trauma or any systemic disease associated with zonular dialysis. Lens dislocation developed with 0.5 to 6 months following laser iridotomy. All patients were male and two eyes were complicated with acute primary angle closure glaucoma preoperatively. Case 1 showed bilateral lens dislocation, while cases 2 and 3 involved unilateral lens dislocation. Cases 2 and 3 showed lenses completely dislocated into the vitreous cavity. All cases needed lens removal and scleral fixation of intraocular lenses. Final visual acuity was 1.2 in all cases. We suspect that laser iridotomy may induce localized zonular dialysis that results in progressive zonular weakness, leading to lens dislocation.

Anterior Chamber Paracentesis Facilitates Laser Peripheral Iridotomy and Restores Vision in Mild-to-moderate Acute Primary Angle-closure Glaucoma

Purpose Acute primary angle-closure glaucoma (PACG) is an ocular emergency that commonly presents in Asian populations. For patients with contraindications for mannitol infusion, it is imperative to perform an alternative therapy in order to rapidly decrease intraocular pressure (IOP) and prevent further visual complications. The purpose of this study is to evaluate the therapeutic efficiency of anterior chamber paracentesis (ACP) and mannitol infusion in patients with PACG. Methods Patients who suffered from their first attack of acute PACG when receiving ACP or mannitol infusion (20%, 300 mL) were included. They were divided into three subgroups: mild, moderate, or severe acute PACG, according to each patient’s initial IOP upon presentation (mild group, 45–50 mmHg; moderate group, 50–60 mmHg; severe group, >60 mmHg). IOP at multiple time points, best-corrected visual acuity (BCVA), severity of corneal edema, and waiting time for laser peripheral iridotomy (LPI) were recorded. Results Compared with mannitol infusion ( n = 29), ACP treatment ( n = 30) achieved more rapid and effective IOP control within 2 hours, resulted in faster regression of corneal edema (grade: 0.98 ± 0.729 [ACP] vs. 1.50 ± 0.720 [mannitol], p = 0.011), and patients were able to undergo LPI within a reasonable amount of time (1.4 ± 0.93 days [ACP] vs. 2.5 ± 1.17 days [mannitol], p = 0.0002). All patients who received ACP or mannitol demonstrated improved BCVA within 2 weeks. Intriguingly, ACP restored visual acuity more effectively than mannitol infusion in patients with an initial IOP lower than 60 mmHg. Conclusion ACP effectively treats acute PACG by rapidly stabilizing the anterior chamber. When the initial IOP is above 60 mmHg, ACP should only be considered when mannitol is contraindicated.

Comparison of anterior segment changes before and after laser peripheral iridectomy by anterior segment optical coherence tomography in eyes with primary acute angle closure glaucoma

To evaluate the changes of anterior segment configuration after surgical peripheral iridectomy (SPI) in patients with primary acute angle closure glaucoma (PAACG) by using anterior segment optical coherence tomography (AS-OCT). This retrospective self control study consisted of thirty-seven eyes of 37 patients with PAACG who were consecutively recruited in Zhongshan Ophthalmic Center. The peripheral anterior synechiae (PAS) of these patients was less than 5 clock time point. Central anterior chamber depth (ACD), angle opening distance (AOD), trabecular iris area (TISA), angle recess area (ARA), anterior chamber width (ACW), anterior chamber volume (ACV), and crystalline lens rise (CLR) were measured using AS-OCT before and one month after SPI. After SPI, AOD (0.125 ± 0.072) µm, TISA (0.091 ± 0.041) mm(2), ARA (0.095 ± 0.042) mm(2), ACA (14.230 ± 2.000) mm(2) and ACV (90.074 ± 16.796) mm(3) were significantly increased compared with before SPI AOD (0.088 ± 0.078) µm, TISA (0.050 ± 0.048) mm(2), ARA (0.059 ± 0.057) mm(2), ACA (12.332 ± 2.457) mm(2), ACV (73.131 ± 16.976) mm(3) (t = -8.015 to 1.066, P = 0.001 to 0.044), respectively. There were no significantly changes in ACD, ACW and CLR (t = -1.505 to 0.516, P = 0.102 to 0.609). PAACG can be controlled by SPI resulting in an increase of AOD, TISA, ARA, ACA and ACV, but not ACD or CLR.

Safety and efficacy of combined trabeculectomy for primary angle closure glaucoma with persistent ocular hypertension.

To investigate the safety and efficacy of combined trabeculectomy for primary acute angle closure glaucoma with persistent ocular hypertension. A total of 36 patients (40 eyes) with primary acute angle closure glaucoma,who were treated with combined trabeculectomy in the Ophthalmology unit of our hospital,were selected. Before the procedure,patients were assigned to an ocular hypertension group (≥ 40 mmHg) or a control group (<40 mmHg) based on intraocular pressure.These two groups were followed for one year, and compared for post-operative visual acuity, intraocular pressure, filtering bleb, anterior chamber depth, and the occurrence of complications. At 1 week, 6 months, and 12 months after the procedure, intraocular pressure was controlled in both the ocular hypertension group and the control group, without significant differences between the two groups (P>0.05). At 1 week, 6 months, and 12 months after the procedure, all of the patients, in both groups,had improved in terms of visual acuity, with a significant difference before and after the procedure for the ocular hypertension group (P<0.05). After follow-up at 12 months, the two groups presented no statistically significant differences in anterior chamber depth, filtering bleb survival, or the incidence of post-operative complications (P>0.05 for all). It is feasible,safe,and effective to perform combined trabeculectomy on patients with primary acute angle closure glaucoma complicated by persistent ocular hypertension.

The damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma.

To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT). Twenty four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after remission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled less than 21 mm Hg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 month after IOP controlled. Repeated measures ANOVA was used to examine the time course of changes after IOP controlled in RNFL thickness in both acute attack and unaffected fellow eyes of APACG and eyes with CPACG. The mean RNFL thickness (μm) for the APACG-attacked eyes increased significantly within 3 days (121.49±23.84) after acute strike and then became thinner along with time (107.22±24.72 at 2 week, 93.58±18.37 at 1 month, 84.10±19.89 at 3 month and 78.98±19.17 at 6 month). In APACG-attacked eyes, there were significant differences of average RNFL thickness among 5 different times after IOP was controlled (P ＜ 0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness among 5 different times (F = 0.450, P = 0.104 in APACG unaffected fellow eyes and F = 1.558, P = 0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F = 1.912，P = 0.003). RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.

Anatomy parameters in attack eye of primary acute angle-closure glaucoma patients compared to that of contralateral eye

Objective To campare the central corneal thickness (CCT) between the attack eye and contralateral eye in primary acute angle-closure glaucoma(AACG) patients. Methods About 75 primary acute angle-closure glaucoma patients was observed. We measured the CCT of the both eyes in primary acute angle-closure glaucoma by A scan. Also the ACD, thickness of lens and axis were measured when the IOP was reduced. And paired t test was used to compare the difference. Results The mean CCT of the attacked eye of AACG is (576.97 ±50.93) μm while the mean CCT of the contralateral eye is (544.68 ±33.53)(μm. There is significance in CCT between the attacked eye and the contralateral eye(P 0.05). Conclusions CCT was increased in acute angle-closure glaucoma after the attack compared to the contralateral eye which should be considered during the treatment of the AACG patients. Key words: glaucoma,angle-closure,acut; central corneal thickness; ultrasonic pachymetry

Erythropoietin Is Increased in Aqueous Humor of Glaucomatous Eyes

Purpose: To determine the aqueous concentration of erythropoietin (EPO) in patients with and without glaucoma.Methods: Prospective, comparative control study. Concentrations of EPO in the aqueous humor were measured using ELISA kits from 75 patients, of whom 55 had glaucoma (14 primary acute angle-closure glaucoma, PAACG; 26 primary chronic angle-closure glaucoma, PCACG; 11 primary open-angle glaucoma, POAG; 4 neovascular glaucoma, NVG), and 20 had cataract only as control.Results: EPO concentrations in eyes with glaucoma (71.0 ± 12.0 mU/mL) were significantly higher than those in eyes with cataract (6.4 ± 0.8 mU/mL, P < 0.001). There were no significant differences (P = 0.421) between PCACG (28.84 ± 3.9 mU/mL) and POAG (20.2 ± 2.0 mU/mL); however, EPO concentrations in eyes with PAACG (118.5 ± 14 mU/mL) were significantly higher than these two chronic subtypes of glaucoma (P < 0.001, respectively). Unusually high EPO concentrations were detected in four eyes with NVG (319.5 ± 47.7 mU/mL). No effect of age, gender, different eyes, body mass index of the aqueous humor EPO concentration could be detected (P > 0.05). No significant correlation was found between aqueous humor and plasma EPO concentrations in PAACG and control group (P = 0.285, 0.500, respectively).Conclusion: Our prospective study suggests that the aqueous humor EPO concentrations are increased in eyes with glaucoma.

Damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma.

To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT). Twenty-four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after admission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled under 21mmHg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 months after IOP was controlled. Repeated measures ANOVA was used to examine the changes of RNFL thickness at different time after IOP being controlled in both acute attack eyes and unaffected fellow eyes of APACG and eyes with CPACG. The mean RNFL thickness for the APACG-attacked eyes increased significantly within 3 days (121.49±23.84)µm after acute onset and then became thinner along with time [(107.22±24.72)µm at 2 weeks,(93.58±18.37)µm at 1 month, (84.10±19.89)µm at 3 months and (78.98±19.17)µm at 6 months]. In APACG-attacked eyes, there were significant differences of average RNFL thickness at 5 different times after IOP was controlled (P<0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness at 5 different times(F=0.450, P=0.104 in APACG unaffected fellow eyes and F=1.558, P=0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F=1.912, P=0.003). RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.

Retinal Nerve Fiber Layer Thickness After a Single Attack of Primary Acute Angle-Closure Glaucoma Measured With Optical Coherence Tomography

After a single unilateral acute primary angle-closure glaucoma attack, retinal nerve fiber layer (RNFL) may be thinned. The current study measured the RNFL thickness using optical coherence tomography in eyes with normal visual fields after recovery from a single attack of acute primary angle-closure glaucoma. Twenty-one patients and age-matched control subjects underwent optical coherence tomography scanning after recovery from a single unilateral acute primary angle-closure glaucoma attack. Data from the affected eyes, normal fellow eyes, and control subjects were compared. Average RNFL thickness was 91.3 +/- 16.4 microm in the affected eyes, 100.1 +/- 16.4 microm in the fellow eyes, and 100.2 +/- 16.7 microm in the control eyes. Significant thinning was present in the affected eyes compared to the fellow eyes (P = .001) and the control eyes (P = .04). RNFL thickness was found to be significantly thinner in the eyes with angle-closure glaucoma.

Bilateral Acute Angle-Closure Glaucoma in a Migraine Patient Receiving Topiramate: A Case Report

Background: Patients with migraine headaches are frequently prescribed topiramate to treat their condition. Case Report: We present a case of bilateral acute angle-closure glaucoma occurring 2 days after topiramate therapy was increased for symptoms related to migraine. Conclusion: Acute angle-closure glaucoma secondary to topiramate is an uncommon but serious adverse reaction that may result in severe morbidity such as permanent visual loss if not recognized in a timely manner. Treatment differs from primary acute angle-closure glaucoma in that discontinuation of topiramate is necessary for the glaucoma to resolve.

Phacoemulsification Treatment of Subjects With Acute Primary Angle Closure and Chronic Primary Angle-closure Glaucoma

To investigate and compare the effects of phacoemulsification as an initial procedure to control intraocular pressure (IOP) in eyes with acute primary angle closure (APAC) and chronic primary angle-closure glaucoma (CPACG) with coexisting cataracts and peripheral anterior synechiae (PAS) of greater than 180 degrees. Prospective, cross-sectional study. Thirteen patients (13 eyes) with APAC and 10 patients (10 eyes) with CPACG were enrolled in the study. IOP control in the 2 groups was compared at final follow-up. Other outcome measures included visual acuity, anterior chamber depth, gonioscopic appearance, and complications. The postoperative IOP was reduced in both the APAC and CPACG groups. As assessed at last follow-up (median 6 mo), IOP in the APAC group was significantly lower than that in the CPACG group. The absolute success rate was 100% in the APAC group and 80% in the CPACG group. The number of hypotensive medications decreased in both APAC and CPACG group. The postoperative degree of PAS was relieved in 11 of 12 eyes with APAC and 5 of 9 eyes with CPACG. Initial phacoemulsification performed to provide short-term control of IOP is more efficacious in patients with APAC than in those with CPACG, especially when PAS is greater than 180 degrees.

Long-term outcomes of laser peripheral iridectomy for primary angle closure glaucoma

To explore the long-term efficacy and safety of laser peripheral iridectomy for primary angle closure glaucoma (PACG). It was a retrospective case series study. Data were collected from those patients who received laser peripheral iridectomy (LPI) for acute or chronic PACG from April 1992 through October 2002 at the Peking Union Medical College Hospital. Only patients who were followed for at least 5 years were included in this study. The control of intraocular pressure (IOP), visual acuity and managements after LPI were analyzed. All of the studied eyes were re-classified into three categories according to the status of anterior chamber angle, optic nerve head and visual field before LPI: primary angle closure suspect (PACS), primary angle closure (PAC) and primary angle closure glaucoma (PACG). Satisfactory control of IOP was defined as the IOP was less than 21 mm Hg (1 mm Hg = 0.133 kPa) without any medications after LPI. No satisfactory control of IOP was defined as the IOP was greater than 21 mm Hg after LPI, yet could be controlled below 21 mm Hg by anti-glaucoma medications. A failure in IOP control was defined as an acute attack of angle closure developed or filtering surgery was required to control IOP after LPI. Chi-square analysis was used for comparison of IOP control in different groups. One hundred and thirty one patients (251 eyes) with PACG were eligible for this study. The mean follow-up period was (9.2 +/- 3.7) years. Of the 251 eyes, 18 eyes (7.2%) were identified as PACS, 98 eyes (39.0%) PAC, 129 eyes (51.4%) PACG, and 6 eyes (2.4%) could not be classified owing to the lack of the information on the optic nerve head and visual field before LPI. The rates of satisfactory control of IOP were 27.1% in all eyes, and 88.9% (16/18), 38.8% (38/98) and 10.9% (14/129) in PACS, PAC and PACG eyes respectively. The rates of no satisfactory control of IOP were 59.8% in all eyes, and 5.6% (1/18), 48.0% (47/98) and 75.2% (97/129) in PACS, PAC and PACG eyes respectively. The rates of failure in IOP control were 13.1% in all eyes, and 5.6% (1/18), 13.3% (13/98) and 14.0% (18/129) in PACS, PAC, PACG eyes respectively. The difference in IOP control between PACS, PAC and PACG eyes was statistically significant (chi(2) = 59.08, P = 0.000). Only 8 eyes had an acute attack of angle closure after LPI. No long-term complications after LPI were observed in all eyes. The IOP control after LPI in PACG eyes is not so good as expected. However, most of PACG eyes after LPI are free of acute attack of angle closure. PACG eyes should be given close and regular follow-up in a long-term to monitor the IOP control and the progression of PACG after LPI.

Trabeculectomy in Patients With Primary Angle-closure Glaucoma

To analyze the results of trabeculectomy in patients with primary angle-closure glaucoma. A retrospective and noncomparative case series analysis was performed on data from Taiwan, from 2001 to 2004. The outcomes of trabeculectomy in eyes with acute primary angle-closure glaucoma attack (AACG) and those with chronic primary angle-closure glaucoma (CACG) were assessed in terms of final intraocular pressure (IOP), changes to visual acuity, and the incidence of complications. A total of 52 eyes of 52 patients, 15 patients in AACG group and 37 patients in CACG group, were reviewed. The mean follow-up period was 32 months (range, 26-42 mo). In terms of no visual acuity change after surgery, there were significant differences between the CACG and AACG groups (P=0.02, Fisher exact test). In terms of final IOP control, trabeculectomy outcome was significantly worse in patients in the AACG group than those in the CACG group (P<0.01, Fisher exact test). Moreover, the complication of bleb encapsulation appeared more frequently in the AACG group than in the CACG group (P=0.02, Fisher exact test). Compared with CACG, trabeculectomy may not be as good for patients of AACG, because it may lead to worsened visual acuity; it also seems to present a greater failure rate, more complications, and fewer cases of surgical survival.