Angle-closure Attack Research Articles

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.

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.

Recurrent acute angle-closure attacks in age-related macular degeneration-associated massive posterior segment hemorrhage

Recurrent acute angle-closure attacks in age-related macular degeneration-associated massive posterior segment hemorrhage

Reduction in admissions of patients with acute primary angle closure occurring in conjunction with a rise in cataract surgery in Taiwan

Using 8 year nationwide administrative data, this study sets out to investigate the relationship between the total number of cataract operations undertaken in Taiwan and admissions for acute primary angle closure (APAC). Monthly cataract surgery and APAC admission rates, per 100,000 of the population, were provided by 1997-2004 inpatient and outpatient data obtained from the Taiwanese National Health Insurance Research Database. The 3814 cases of APAC and 503 687 patients who had undergone cataract operations were categorized by age groups (40-49, 50-59, 60-69 and > or =70 years) and by gender. Spearman rank correlation coefficients were used to examine the direction and strength of the relationships. Throughout the study period, the admissions for APAC showed a steady decline from 630 cases in 1997 to 351 cases in 2004, while the number of cataract operations revealed a gradual increase from 26 600 in 1997 to 77 924 in 2004. The Spearman rank correlation coefficients showed significant inverse relationships between monthly APAC admission rates and monthly cataract operation rates for the total group (r = -0.407, P < 0.001), males (r = -0.330, P < 0.001), females (r = -0.444, P < 0.001), 40-49 year olds (r = -0.335, P < 0.001), 50-59 year olds (r = -0.497, P < 0.001) and 60-69 year olds (r = -0.417, P < 0.001). No significant inverse relationship was observed for the > or =70 age group. Significant inverse relationships were noted between the monthly APAC admission rates and the monthly cataract operation rates. We recommend that data should be collected from other regions and ethnic groups to determine the inter-relationships.

Correlation of previous acute angle-closure attack with extent of synechial angle closure in chronic primary angle-closure glaucoma patients

To document any correlation between previous acute angle-closure attack and the extent of synechial angle closure in chronic primary angle-closure glaucoma (PACG) patients. Consecutive cases of chronic PACG with patent peripheral iridotomy had gonioscopy performed. The extents of synechial angle closure of those chronic PACG eyes with previous documented acute angle-closure attack were compared to those eyes without such a history. A total of 102 chronic PACG eyes of 102 patients were recruited. Twenty-seven eyes (26.5%) had a previous documented acute angle closure, while 75 eyes (73.5%) did not. The mean extent of synechial angle closure +/-1 SD was 307+/-68 degrees (range, 150-360 degrees) in those chronic PACG eyes with a history of previous acute angle closure, compared to 266+/-89 degrees (range, 90-360 degrees) in those chronic PACG eyes without such a history (P=0.03, Student's t-test). There were no statistically significant differences between the two groups in age, LogMAR visual acuity, intraocular pressure (IOP), number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern SD in Humphrey automated perimetry, and anterior chamber depth (P>0.05). Previous acute angle-closure attack correlated with more extensive synechial angle closure in chronic PACG patients in this study.

Current Understanding of the Treatment and Outcome of Acute Primary Angle Closure Glaucoma: An Asian Perspective

Introduction: Primary angle-closure glaucoma (PACG) is a major cause of blindness among Asians. A better understanding of the disease will improve the treatment and outcome of this condition. Methods: A literature review of all recent publications on PACG was carried out. Articles were retrieved using a key word search of MEDLINE, PubMed and Science Citation Index databases. Results: Following laser peripheral iritodomy for acute angle-closure, Asians were found to have a higher tendency to develop a subsequent rise in intraocular pressure compared to Caucasians. Furthermore, the extent and severity of visual field damage was more severe in Asians than Caucasians, particularly in eyes that presented insidiously with chronic PACG. Prophylactic laser iridotomy in the contralateral eye was found to be highly effective in preventing acute angle-closure attacks. Conclusion: PACG is more difficult to manage and is associated with more severe long-term visual morbidity in Asians than Caucasians. Regular follow-up of patients with PACG is important for the early detection of progression of the disease and visual field deterioration.

Simultaneous Bilateral Acute Angle-closure Glaucoma in a Patient With Subarachnoid Hemorrhage

To present an unusual case of simultaneous bilateral acute angle-closure (AAC) glaucoma in a patient with subarachnoid hemorrhage due to an aneurysm involving the right middle cerebral artery. A 60-year-old woman with a clinically inexplicable bilateral nonreacting mydriasis after brain surgery underwent an ophthalmologic consultancy. The bilateral mydriasis was diagnosed as an unusual clinical presentation of simultaneous bilateral AAC glaucoma. One week after the AAC was bilaterally resolved, the patient underwent echographic examination because of the outbreak of a unilateral relapsed ocular hypertensive attack that required an ultrasound biomicroscopy (UBM) to be accurately diagnosed and treated. The bilateral AAC regressed completely after pharmacologic therapy. UBM evaluation of the eye with recurrence of the angle-closure glaucoma attack was necessary to confirm the diagnosis of unilateral relapsed angle-closure glaucoma due to an unresolved pupillary block. A viscoelastic-aided opening of the angle and peripheral surgical iridectomy were performed. UBM and tonometry were performed intraoperatively to confirm the success of the surgical treatment. The UBM allowed us to identify the pupillary block as the main mechanism involved in the pathogenesis of this unusual case of simultaneous bilateral AAC glaucoma. Despite the fact that drug-induced supraciliary uveal effusion and mydriasis due to surgical anesthesia have been frequently reported to contribute to this complication, we presumed that simultaneous intravenous administration of sedative drugs and adrenergic agonists, in a patient with individual biometric predisposing factors to the angle-closure, created the anatomic conditions which induced the pupillary block with obliteration of the trabeculum.

Retinal tear and raised intraocular pressure following unintentional intraocular botulinum toxin type A injection

Case report: A 67-year-old woman with a 30-year history of dysthyroid orbitopathy and diplopia had an inadvertent injection of botulinum toxin type A into the vitreous cavity. Full pupil mydriasis and an intraocular pressure (IOP) of 50 mm Hg in the right eye were noted after the injection. An attack of acute angle closure was initially suspected despite a patent peripheral iridotomy (PI). The episode resolved with topical and intravenous IOP-lowering agents. Postoperative retinal examination revealed a retinal tear, which was successfully treated with laser photocoagulation. Visual acuity returned to baseline within 2 weeks, and the results of further retinal examinations remained stable. Comments: This case supports the animal studies and human case reports that have demonstrated no retinal toxicity after intraocular injections of botulinum toxin type A. Temporary mydriasis and elevated IOP that may occur after injection do not appear to be detrimental and can be treated with topical and intravenous IOP-lowering agents. Transiently elevated IOP after injection is most likely due to volume increase, though acute angle closure with occlusion of the PI might be considered.

Ocular Biometry in Acute and Chronic Angle-Closure Glaucoma

Aim: To evaluate the biometric difference between eyes with acute angle-closure (AAC) attack, their uninvolved fellow eyes and eyes with chronic angle-closure glaucoma (CACG). Methods: Patients with prior laser iridotomy on both eyes for unilateral AAC attack or CACG were recruited. We compared ocular biometric parameters by A-scan ultrasonography of the acutely affected eyes with those of the uninvolved fellow eyes and with eyes affected by CACG. Results: Thirty-three patients with unilateral AAC attack and 41 patients with CACG were included. The eyes with AAC attack had a significantly shallower anterior chamber depth (ACD), thicker lens, shorter axial length, higher lens/axial length factor and more anteriorly positioned lens than the eyes with CACG. The uninvolved fellow eyes had a significantly shallower ACD, shorter axial length and higher lens/axial length factor compared with the eyes with CACG. Acutely affected eyes had a shallower ACD and more anteriorly positioned lens than did the uninvolved fellow eyes. Conclusion: Eyes with AAC attack had a more crowded anterior segment compared with uninvolved fellow eyes and those affected by CACG. In addition to ACD, relative lens size, represented by the lens/axial length factor, and relative lens position appear to play important roles in the development of AAC attack.

Effect of a Previous Acute Angle Closure Attack on the Corneal Endothelial Cell Density in Chronic Angle Closure Glaucoma Patients

To document the effect of a previous acute angle closure attack on the corneal endothelial cell density in chronic angle closure glaucoma (CACG) patients. Consecutive cases of CACG with patent peripheral iridotomy had their central corneal endothelial cell density measured by specular microscopy. The corneal endothelial cell density of those CACG eyes with a previous documented acute angle closure attack were compared with those eyes without such a history, to determine the effect of a previous acute angle closure attack on corneal endothelial cell density. From July 2003 to July 2005, a total of 52 CACG eyes of 52 patients fulfilling the study criteria were recruited. Thirteen eyes (25%) had a previous documented acute angle closure attack, whereas 39 eyes (75%) did not. The mean central corneal endothelial cell density +/-1 standard deviation was 2271.7+/-312.9 (range, 1556 to 2661) cells/mm in those CACG eyes with previous acute angle closure, and 2570.0+/-429.9 (range, 1669 to 3861) cells/mm in those CACG eyes without previous acute angle closure (P < 0.05, Student t test). A previous acute angle closure attack in a CACG eye correlates with a 11.6% reduction in corneal endothelial cell density, compared with a CACG eye without such a history. There were no statistically significant differences between the 2 groups in age, LogMAR visual acuity, intraocular pressure, number of glaucoma eye drops, vertical cup-to-disk ratio, mean deviation or pattern standard deviation in Humphrey automated perimetry (P > 0.05). A previous acute angle closure attack correlates with a significantly reduced corneal endothelial cell density in CACG patients.

Anterior chamber paracentesis in patients with acute elevation of intraocular pressure

The purpose was to evaluate the efficacy and the safety of anterior chamber paracentesis (ACP) in acute elevation of intraocular pressure (IOP). We prospectively enrolled 20 patients who presented with acute unilateral elevation of IOP above 50 mmHg. IOP was measured before, 10 min, and 1, 7 and 30 days after ACP. The outcome at 1 year was available in 19 patients. The patients included 14 cases of primary acute angle-closure attacks and six cases of secondary glaucoma. IOP decreased from 53.4 +/- 4.2 mmHg to 24.1 +/- 12.5 mmHg at 10 min, to 18.2 +/- 11.1 mmHg at 24 h, and to 16.4 +/- 10.7 mmHg 7 days after ACP. ACP combined with antiglaucomatous medications provided immediate relief of symptoms in all cases and improvement of corneal oedema in 17 cases. We noted three failures in secondary glaucoma. We performed a laser peripheral iridotomy (LPI) in 14 patients and a surgical procedure in 17 eyes. No complications related to ACP were observed. ACP is a safe and effective procedure for acute elevation of IOP in acute primary primary angle-closure but only remains an add-on therapy to usual treatments. However, this technique must be evaluated in larger series.

Acute angle-closure glaucoma precipitated by local tiotropium absorption

Acute angle-closure glaucoma is a rare form of glaucoma occurring when the filtration mechanism for the aqueous humor is obstructed by apposition of the peripheral iris to the trabecular meshwork. It may be precipitated by pupillary dilatation in a predisposed eye. In this case report, a possible relationship between local tiotropium absorption and acute angle-closure glaucoma attack is presented.

Long-term Outcomes in Fellow Eyes after Acute Primary Angle Closure in the Contralateral Eye

To determine the long-term outcome of the contralateral eye in Asian persons with a unilateral attack of acute primary angle closure (APAC). Cross-sectional observational case series. Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals. All subjects underwent a complete eye examination. The optic discs were graded clinically and photographically for the presence of glaucomatous optic neuropathy, and automated visual field tests were assessed for damage. All visual fields and optic nerve photographs (when available) underwent a second evaluation by a masked glaucoma specialist, who assessed whether the changes were compatible with glaucoma. Glaucomatous optic neuropathy, intraocular pressure (IOP), and visual impairment (defined as best-corrected visual acuity of worse than 6/12). Ninety of 138 eligible patients (65.2%) with APAC were examined, 79 with unilateral attacks. Subjects were predominantly Chinese (n = 68; 86%). There were 54 females (68%), and mean age was 68.5+/-8.9 years (standard deviation) at the time of APAC, with a mean duration of 6.3+/-1.5 years from the time of the APAC episode to the study examination. The contralateral eyes of 7 patients (8.9%) had definite or probable glaucoma, 2 of whom were felt to have glaucoma in that eye at the time of the attack. Three eyes had markedly cupped optic discs (cup-to-disc ratio > or = 0.9). Thirteen eyes (16.9%) had best-corrected vision worse than 6/12, due to cataract in almost half the cases. Only 1 eye had vision < 6/60, the cause of which was corneal decompensation. One other patient had only a central island remaining with vision of 6/12. Mean IOP of the study participants was 15.7+/-4.7 mmHg, with 6 subjects (7.6%) having undergone trabeculectomy. Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5%) fellow eyes and developed in an additional 5 (6.5%) with a mean follow-up of 6 years. More than 80% of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.

L’iridoplastie au laser Argon dans le traitement du glaucome par fermeture de l’angle avec iris plateau

Plateau iris predisposes to the onset of an angle-closure glaucoma attack without pupillary block. This is a morphological anomaly of the iris characterized by anterior insertion, root thickness greater than the norm, and anterior rotation of the ciliary processes into the posterior chamber, pushing the base of the iris into the angle. Argon laser iridoplasty is useful to retract the peripheral iris using the thermal effect of the laser to widen the iridocorneal angle. The study investigated nine eyes of five patients who had had iridoplasty for iris plateau angle-closure glaucoma, diagnosed by dynamic gonioscopy (or indentation gonioscopy) and confirmed by ultrasound biomicroscopy (UBM). There were four females and one male, with a mean age of 42.2 years (range, 30-53 years). The mean intraocular pressure (IOP) before iridoplasty was 21.1 mmHg. The number of antiglaucoma treatments was 1 or 2, with all patients receiving miotic treatment. All patients had undergone argon laser iridotomy beforehand to remove the pupillary block frequently associated with iris plateau. Iridoplasty was done in two sessions with postoperative IOP-lowering treatment. The laser parameters used were: duration, 0.3 s; power, 500 mW; diameter, 300 microm. The postoperative IOP evaluated at 1 month was 14.4 mmHg with a reduction in the hypotensive treatment. No treatment was prescribed for four eyes, a single hypotensive treatment for four eyes, and two hypotensive medications for one eye. Pure iris plateau syndrome, leading to closure of the angle, is very rare compared to pupillary block, but these two mechanisms often co-exist. The physiopathology explains that the mechanism of isolated iris plateau is not modified by iridectomy. However, the advantage of argon laser iridoplasty, which retracts the periphery of the iris so as to widen the iridocorneal angle, must be emphasized. This technique can alleviate the need for high-risk filtering surgery, but longer follow-up is necessary to evaluate its duration and efficacy.

Optical Coherence Tomography Measurement of Retinal Nerve Fiber Layer After Acute Primary Angle Closure With Normal Visual Field

To detect retinal nerve fiber layer (RNFL) thickness after a single acute primary angle closure (APAC) attack with normal visual field. Prospective, observational case study. Twenty-eight patients who had a single unilateral APAC attack associated with normal visual fields at three months after remission and 28 single eyes from normal controls were enrolled. Duration of APAC attack was 5.9 +/- 2.7 hours. Comparisons of average RNFL thickness and RNFL thickness in four quadrants and in 12-o'clock-hour segments of the attacked eyes, unaffected fellow eyes, and normal controls were made using fast RNFL thickness (3.4) of Stratus optical coherence tomography. Significant differences were demonstrated comparing the inferior-quadrant RNFL thicknesses for the attacked eyes with those of the normal controls (P = .02) and fellow eyes (P = .02) using one-way analysis of variance with Tukey's tests. Inferior region RNFL thickness was significantly decreased in the attacked eyes after an APAC episode associated with normal visual field.

Visualization of Anterior Chamber Angle Dynamics Using Optical Coherence Tomography

To describe the technology of optical coherence tomography (OCT) in imaging the anterior chamber angles and its impact on understanding the pathophysiology of angle-closure glaucoma (ACG). Observational case series. Three subjects with, respectively, impending angle-closure attack, plateau iris syndrome, and phacomorphic glaucoma were recruited. The anterior chamber angle in each patient was imaged with a commercially available OCT unit. The angle configurations were assessed and compared before and after laser peripheral iridotomy (LPI) and argon laser peripheral iridoplasty (ALPI). Visualization of the changes in the anterior chamber angle configurations and normalization of the intraocular pressure (IOP). A patient with impending angle-closure attack precipitated by a topical mydriatic agent was treated with LPI. Optical coherence tomography imaging of the anterior chamber angles was performed before and after the laser procedure. Conversion of anterior iris bowing and angle crowding to iris straightening and angle opening after LPI was demonstrated. Intraocular pressure became normalized with the change in angle configuration. The second patient presented with symptoms of intermittent angle-closure attacks and was initially diagnosed with primary ACG. Despite successful LPI, the angles remained occludable, and the IOP continued to be elevated. Optical coherence tomography was used to review the anterior chamber angle configuration and demonstrated a typical pattern compatible with the diagnosis of plateau iris syndrome. Subsequent ALPI converted the plateau configuration to open angle, with normalization of IOP and disappearance of symptoms. The third patient presented with an acute angle-closure attack and was diagnosed with phacomorphic glaucoma. Argon laser peripheral iridoplasty was performed successfully to open the angle, as evident by the OCT images, and the IOP was brought under control, together with relief of symptoms. The commercially available OCT unit can be practically employed for anterior chamber angle imaging. The different patterns of angle configurations are correlated with the underlying pathophysiology in different forms of ACG.

UK national survey of prophylactic YAG iridotomy.

Acute angle-closure glaucoma is a common ophthalmic emergency and individuals with shallow anterior chambers and suspected narrow angles are increasingly referred to the hospital eye service for assessment. There appears to be variation in subsequent management, with no national consensus or college guidelines. This study ascertains the current use of prophylactic YAG iridotomy in patients with no known history of an acute angle-closure glaucoma attack, and also the methods used in patient selection. Questionnaire-based survey mailed to 650 UK consultant ophthalmologists with a covering letter in 2003. A total of 546 questionnaires were returned. In all, 408 respondents (74.7%) confirmed they perform prophylactic YAG iridotomy and of these 347 (85.0%) use patient symptoms and 268 (65.6%) presenting IOP in patient selection, 394 (96.6%) perform gonioscopy and 97 (23.8%) use some form of provocative test first. A total of 135 (25.3%) stated they do not perform this procedure. This study reveals current national practice among UK ophthalmologists, with variations in the assessment of patients with narrow angles but a high uptake of prophylactic YAG iridotomy.

Spontaneous, late, in-the-bag intraocular lens subluxation in a patient with a previous acute angle-closure glaucoma attack

Cataract surgery was performed in a 49-year-old woman 16 months after an acute angle-closure glaucoma attack. Zonular dialysis was observed during surgery, but the intraocular lens (IOL) was implanted in the capsular bag uneventfully. At 4 1 ⧸ 2 months, 1 IOL loop wrapped in the bag herniated into the anterior chamber. The patient had no history of trauma. The IOL loop remained in the anterior chamber for 9 months, until the subluxated IOL spontaneously returned to its original position. Six months later, the IOL again dislocated into the anterior chamber.

Long-term outcomes in asians after acute primary angle closure

Purpose To determine the long-term outcome of Asian eyes with an acute attack of primary angle closure (APAC) and to identify risk factors at presentation associated with the development of glaucomatous optic nerve damage. Design Cross-sectional observational case series. Participants Ninety individuals who were initially seen with APAC 4 to 10 years previously at 2 Singapore hospitals. Methods All subjects underwent a complete eye examination, including visual acuity, visual field testing, dilated eye examination, and optic nerve head photography. The optic discs were judged clinically and photographically as to whether there was glaucomatous optic neuropathy present, and visual fields were assessed for corresponding visual field loss. All visual fields and optic nerve photographs underwent a second evaluation by an experienced, but masked, glaucoma specialist, who assessed whether the changes were compatible with glaucoma. Main outcome measures The main outcome measures were blindness (defined as best-corrected visual acuity worse than 6/60 and/or central visual field of less than 20° in the attack eye) and glaucomatous optic neuropathy (GON). Results A total of 90 of 170 eligible subjects (65.2%) were examined. All subjects were Asian and were predominantly Chinese (78 subjects [86.7%]). There were 61 females (67.8%), and the age of the subjects was 62.0±9.0 years (mean ± standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. Sixteen (17.8%) subjects were blind in the attack eye; half of the cases of blindness were caused by glaucoma. Forty-three subjects (47.8%) had GON, with 13 eyes (15.5%) having markedly cupped optic discs (cup-to-disc ratio >0.9). Thirty-eight eyes (58%) had best-corrected vision worse than 6/9, with cataract responsible for close to half the cases of poor vision. There were no identifiable risk factors related to the APAC episode that were significantly associated with the presence of GON. Conclusions Several years after being seen with APAC, 17.8% of subjects examined were blind in the attack eye, and almost half had glaucomatous optic nerve damage. Vision was also reduced in a large number of individuals, largely from unoperated cataract. Subjects with APAC would benefit from regular follow-up to monitor for visual field decline and glaucoma development.

Re: Laser Peripheral Iridoplasty as Initial Treatment of Acute Attack of Primary Angle-Closure: A Long-Term Follow-Up Study: Reply to Letter to the Editor

Re: Laser Peripheral Iridoplasty as Initial Treatment of Acute Attack of Primary Angle-Closure: A Long-Term Follow-Up Study: Reply to Letter to the Editor