Chronic Primary Angle-closure Glaucoma Patients Research Articles

Comparative of OCT and OCTA parameters in patients with early chronic angle-closure glaucoma and early pituitary adenoma

Optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) have the potential application in evaluating pathological structural change of the optic nerve. We aimed to evaluate the value of the OCT and OCTA parameters of the optic disk and macular in differentiating early chronic primary angle-closure glaucoma (CPACG) and early pituitary adenoma (PA) in case of mild visual field defects (the mean defect (MD) > 6 dB). The results showed that regarding OCTA parameters, CPACG patients had lower retinal blood flow density of most layers of the optic disk and macular than PA patients. Regarding OCT parameters, CPACG patients had thinner circumpapillary retinal nerve fiber layer (CP-RNFL) in all quadrants and average CP-RNFL, ganglion cell layer (GCL) and macular ganglion cell complex (GCC) in each quadrant of macular inner and outer rings, and inner plexus layer (IPL) of macular inner ring, superior-outer ring and temporal-outer ring than PA patients. The Z test indicated that OCTA parameters and OCT parameters had similar value in the diagnosis of disease. In conclusion, in the case of similar visual field damage, early CPACG patients have smaller blood flow density and thinner optic disk and macular than early PA. OCTA has similar performance to OCT in diagnosing CPACG and PA.

Anterior Segment Parameter Changes after Cataract Surgery in Open-Angle and Angle-Closure Eyes: A Prospective Study.

Background: To investigate the anterior segment parameters before and after cataract surgery in open-angle eyes and different subtypes of primary angle-closure glaucoma (PACG) eyes and to further explore the potential relationship between the anterior rotation of the ciliary process and crystalline lens. Methods: An observational, prospective study was performed on 66 patients who had cataract surgery including 22 chronic PACG patients, 22 acute PACG patients, and 22 open-angle cataract patients. Anterior segment parameters including the trabecular-ciliary process distance, ciliary process area, trabecular-ciliary angle (TCA), maximum ciliary body thickness (CBTmax), and so on, were measured using ultrasound biomicroscopy preoperatively and 3 months postoperatively. Results: After the surgery, there were significant increases in TCA (p < 0.001) and CBTmax (p < 0.05) in all three groups, while there was no significant change in the trabecular-ciliary process distance (p > 0.05) in all three groups. No significant difference in the changes of ciliary process area, TCA, and CBTmax (p > 0.05) pre- and postoperatively among the three groups were identified. Conclusions: Extractions of crystalline lenses played similar roles in terms of decreasing the anterior rotation of ciliary processes in open-angle eyes and angle-closure eyes. A natural anatomical abnormality may be a more important factor in the anterior rotation of ciliary processes in PACG patients.

CORRELATION BETWEEN LOCUS POLYMORPHISM OF COL11A1 GENE AND OCULAR BIOMETRY IN ACUTE AND CHRONIC PRIMARY ANGLE CLOSURE GLAUCOMA

Objective: The objective of this study is to analyze the correlation between locus polymorphisms of genetics variants of rs3753841 (COL11A1) and ocular biometry, including anterior chamber depth (ACD), axial length (AL), and lens thickness (LT) in acute and chronic primary angle-closure glaucoma (PACG) patients.&#x0D; Methods: A total of 50 patients consisting of 25 acute PACG and 25 chronic PACG patients were included in this study. Ocular biometric parameters including anterior ACD, AL, and LT measurement were performed in all subjects using A-scan biometry. DNA isolation from blood samples was performed using PCR sequencing for genotyping locus polymorphisms of rs3753841 (COL11A1).&#x0D; Results: Mean ACD was shallower (2.40±0.40 mm), mean AL was shorter (21.86±1.31 mm), and mean LT was thicker (5.01±0.49 mm) in acute PACG compared to chronic PACG group, yet with no significant difference (p&gt;0.05). We found a statistically significant difference of rs3753841 (COL11A1) polymorphism, with heterozygous mutant was mostly found in chronic PACG and homozygous mutant was mostly found in acute PACG patients (p&lt;0.05). Significant correlations were also found between the locus polymorphism and ocular biometry (ACD and AL) in chronic PACG (p&lt;0.05).&#x0D; Conclusion: We confirmed the polymorphisms of rs3753841 (COL11A1) in both groups and its significant correlation with ocular biometry (ACD and AL) in chronic PACG.

Biometric indicators of eyes with occult lens subluxation inducing secondary acute angle closure

BackgroundTo compare the anterior biometrics in eyes with secondary acute angle closure induced by occult lens subluxation (ASAC-LS), misdiagnosed as acute primary angle closure (APAC) at the first visit with APAC, chronic primary angle closure glaucoma (CPACG), and cataract.MethodsThis retrospective case study included 17 eyes with angel closure due to occult LS, who were misdiagnosed as APAC on their first visit, 56 APAC eyes, 54 CPACG eyes, and 56 cataract eyes. Axial length (AL), central corneal thickness (CCT), anterior chamber depth (ACD), aqueous depth (AD) and lens thickness (LT) were recorded. Lens position (LP), relative lens position (RLP), corrected lens position (CLP) were calculated. Quantitative data were subject to one-way analysis of variance and correlation analysis. Categorical data were analyzed using the chi-squared test. Receiver operating characteristic (ROC) curves were plotted to obtain a suitable cutoff value of ocular biometrics.ResultsThe ASAC-LS patients had a longer ocular axial length than APAC and CPACG patients. Central corneal thickness of the ASAC-LS patients was not significantly different from APAC patients, but was significantly different from CPACG and cataract patients. The APAC patients had the smallest ACD, while the ASAC-LS patients had the smallest AD. The ASAC-LS patients had the largest lens thickness. According to ROC curve analysis, RLP, ACD, AD, CLP, LP had high power of discrimination.ConclusionsThis study revealed that LS secondary PAC patients had a shallower AD, thicker CCT comparing to those of APAC, CPACG and cataract patients. For patients with acute angle-closure glaucoma, it is necessary to exclude lens zonula relaxation.Trial registrationNCT03752710, retrospectively registered.

One-month IOP in mitomycin C-augmented trabeculectomy can predict long-term IOP control in chronic primary angle-closure glaucoma.

To investigate the predictors of long-term intraocular pressure (IOP) in chronic primary angle-closure glaucoma (CPACG) treated with primary trabeculectomy. This study systematically reviewed cases of CPACG treated with primary trabeculectomy. The scleral flaps in all cases were sutured with two stitches in situ and two releasable sutures to ensure watertight under normal IOP conditions during surgery. Mitomycin C was used in all eyes. All patients were followed for 2years. Digital massage of the bulbus and removal of the releasable suture were performed according to the IOP and shape of the filtering bleb. Demographic data and clinical outcomes were recorded. Factors predicting long-term IOP were identified. A total of 72 patients (88 eyes) with a mean age of 58.51 ± 10.60years were included in this study. The complete success rate was 89.77% after 2years. The IOP began to stabilize after 7days and reached its lowest point at the 1-month follow-up. The preoperative and early postoperative high or low IOP does not affect long-term effects (P > 0.05). There was a positive correlation between postoperative IOP at the 1-month and 2-year follow-ups (r = 0.64, P < 0.001). In CPACG patients undergoing primary trabeculectomy, scleral flaps sutured watertightly with two stitches in situ and two releasable sutures under normal IOP conditions can ensure controllable, effective and safe treatment of CPACG. The preoperative and early postoperative high or low IOP does not affect long-term effects. One-month postoperative IOP can be used as a predictor of long-term IOP control.

Measurement of Structural Parameters of the Lamina Cribrosa in Primary Open-Angle Glaucoma and Chronic Primary Angle-Closure Glaucoma by Optical Coherence Tomography and Its Correlations with Ocular Parameters

Purpose: To measure lamina cribrosa thickness (LCT) and anterior lamina cribrosa surface depth (ALCSD) in primary open-angle glaucoma (POAG), chronic primary angle-closure glaucoma (CPACG), and control patients using spectral-domain optical coherence tomography (SD-OCT) and examine its association with relevant ocular parameters. Methods: In this cross-sectional study, 61 healthy volunteers (61 eyes), 65 POAG patients (65 eyes), and 55 CPACG patients (55 eyes) were recruited to obtain radial B-scans of the optic nerve head by way of enhanced depth imaging using Heidelberg SD-OCT. The obtained LCT and ALCSD were compared among the control, POAG, and CPACG groups. In addition, we evaluated the relationships of mean lamina cribrosa (LC) parameters with visual field (VF) mean deviation (MD), retinal nerve fiber layer (RNFL) thickness, intraocular pressure (IOP), and axial length. Results: The mean LCT of CPACG eyes was greater than that of POAG eyes (p = 0.003), but less than that of normal eyes (p < 0.001). The mean ALCSD of POAG and CPACG eyes was greater than that of normal control eyes (both p < 0.001). However, the mean ALCSD showed no significant difference between the POAG and CPACG groups (p = 0.073). Among all eyes, lower MD and thinner RNFL thickness were associated with a deeper and thinner LC (all p < 0.001). Conclusion: LCT is thinner in POAG compared to CPACG eyes. This is compatible with less deformation and compression of the LC in CPACG eyes, implying that the mechanisms of glaucomatous damage are different between POAG and CPACG eyes. Furthermore, VF MD and RNFL thickness were related to LCT and ALCSD in all patients.

Multiplex Cytokine Analysis of Aqueous Humor from the Patients with Chronic Primary Angle Closure Glaucoma

ABSTRACTPurpose: To compare the levels of cytokines and growth factor in aqueous humor of the patients with chronic primary angle closure glaucoma (PACG) and cataract.Methods: Aqueous humor samples were collected from 19 chronic PACG patients and compared with 14 nonglaucomatous controls presenting for cataract surgery. The levels of 27 cytokines and growth factors were measured in the aqueous samples using multiplex bead immunoassay and compared across groups.Results: Significantly higher levels of interleukin (IL)-8 (p < 0.001), eotaxin (p < 0.001), interferon gamma-induced protein (IP)-10 (p < 0.001) and macrophage inflammatory protein-1-beta (MIP-1β; p < 0.001) were observed in aqueous of chronic PACG patients compared to controls. In comparison to controls, significantly lower levels of IL-9 (p = 0.001), IL-17 (p < 0.001), tumor necrosis factor-alpha (TNF-α; p < 0.001), granulocyte–macrophage colony-stimulating factor (GM-CSF; p < 0.001), and IL-5 (p = 0.001) were observed in chronic PACG eyes. All other assayed cytokines—IL-1β, interleukin-1 receptor antagonist (IL-1rα), IL-6, IL-7, IL-10, IL-12, IL-13, IL-15, fibroblast growth factor-basic (FGF-basic), granulocyte colony-stimulating factor (G-CSF), monocyte chemotactic protein-1 (MCP-1), macrophage inflammatory protein-1-alpha (MIP-1α), and vascular endothelial growth factor (VEGF) —showed no significant difference between the groups.Conclusions: These results suggest that the aqueous cytokine levels of chronic PACG eyes differ significantly from nonglaucomatous eyes. This is the first study reporting significantly increased levels of eotaxin, MIP-1β, and IP-10 and lower levels of TNF-α, IL-5, IL-9, IL-17, and GM-CSF in chronic PACG patients, suggesting a plausible role of these inflammatory cytokines in its pathogenesis.

Comparing the lamina cribrosa in eyes with primary open angle glaucoma and chronic primary angle closure glaucoma

Objective To compare the lamina cribrosa parameters between primary open angle glaucoma (POAG) and chronic primary angle closure glaucoma (CPACG) eyes. Methods A total of 73 POAG eyes (73 subjects), 64 CPACG eyes (64 subjects), and 40 normal control eyes (40 subjects) with matched ages were included in this cross-sectional observational study. No significant difference was found in sex (χ2=2.07) and age (F=0.38) among three groups (P>0.05). The intraocular pressure, average retinal nerve fiber layer (RNFL) thickness and average visual field defect were not significantly different between POAG and CPACG patients (F=15.67, 21.15, 44.40, 27.99; P<0.05). All subjects underwent spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging (EDI). The optic nerve head was scanned radially at the angle of 20; six high resolution B-scan images were obtained from each eye. The center and para-center lamina cribrosa thickness (LCT) and anterior lamina cribrosa surface depth (ALCSD) were measured in each image. The mean LCT and ALCSD were recorded as the average of the LCT and ALCSD of the 6 images and compared among POAG, CPACG and normal control eyes. Results The average LCT of normal control eyes were (211.48±12.07) μm, while those of the POAG eyes were (145.43±34.33) μm, CPACG eyes were (156.79±33.66) μm. The mean LCT of the POAG and CPACG eyes were thinner than those of the control eyes (t=-11.76, -9.88; P<0.01). All LCT of the POAG eyes were significantly thinner than those of the CPACG eyes (t=-1.96, P=0.03). The average ALCSD of normal control eyes were (390.73±84.40) μm, while those of the POAG eyes were (558.51±176.66) μm, CPACG eyes were (539.39±177.30) μm, respectively. The average ALCSD of the POAG and CPACG eyes were deeper than those of the control eyes (t=5.65, 4.96; P<0.01). But no significantly different ALCSD was shown between POAG and CPACG eyes (t=0.63, P=0.49). Conclusions POAG and CPACG eyes have thinner LCT and deeper ALCSD than normal eyes. POAG eyes have thinner LCT than CPACG eyes when their visual field defect and damage of RNFL were in the same degree. Key words: Glaucoma, open-angle/diagnosis; Glaucoma, angle-closure/diagnosis; Tomography, optical coherence

A prospective comparison of chronic primary angle-closure glaucoma versus primary open-angle glaucoma in Singapore

To describe the optic disc, visual field and ocular characteristics of a consecutive cohort of Asian patients with chronic primary angle-closure glaucoma (CPACG), and compare them with those having primary open-angle glaucoma (POAG). In a prospective comparative case series of new patients with POAG or CPACG in Singapore, all patients underwent visual acuity assessment, slit-lamp examination, tonometry, gonioscopy, refraction, Heidelberg Retina Tomograph (HRT) and Humphrey visual field (HVF) assessment. 98 patients were enrolled (POAG n = 48; CPACG n = 50). CPACG patients were significantly older (66.5 ± 9.2 years vs. 64.1 ± 13.5 years; p = 0.027) and mostly female (p = 0.004). CPACG eyes had significantly higher intraocular pressure (26.9 ± 6.9 mmHg vs. 24.5 ± 3.3 mmHg; p = 0.03), shorter axial length (22.89 ± 0.97 mm vs. 24.26 ± 1.79 mm; p < 0.001) and shallower anterior chamber depth (2.60 ± 0.25 mm vs. 3.16 ± 0.48 mm; p < 0.001). HVF mean deviation or pattern standard deviation (PSD) did not differ significantly between POAG and CPACG eyes, but the latter had a lower PSD for a given mean deviation. HRT parameters between the two groups were not significantly different. In this study, CPACG eyes had significantly higher presenting intraocular pressure than POAG eyes, but there were no significant differences in optic disc topography. A majority of the patients in both groups had moderate field defects at the time of presentation, followed by severe and then mild defects. The field loss in CPACG eyes was more diffuse than that in POAG eyes.

Corneal Status in Primary Angle-closure Glaucoma With a History of Acute Attack

The corneal status of patients with primary angle-closure glaucoma (PACG) with a history of acute attack was investigated. This cross-sectional study included 40 eyes of PACG patients with an earlier documented symptomatic acute angle-closure attack (aPACG), 40 uninvolved fellow eyes of aPACG patients (fPACG), 44 eyes of chronic PACG patients without such a history (cPACG), and 50 eyes of age-matched normal participants. All glaucoma patients had patent peripheral iridotomies with adequate intraocular pressure control. The examinations and recorded parameters included visual acuity, intraocular pressure, gonioscopy, vertical cup-to-disc ratio, specular microscopy, central corneal pachymetry, refraction, corneal curvature radius, anterior chamber depth, axial length, and lens thickness measurements, and the presenting intraocular pressure and the duration of acute angle-closure attack for aPACG eyes. The mean endothelial cell density was 2271±80 cells/mm(2) in aPACG, 2458±79 cells/mm(2) in fPACG, 2379±50 cells/mm(2) in cPACG, and 2559±45 cells/mm(2) in controls. The aPACG eyes had significantly lower endothelial cell density compared with normal eyes (P=0.002). There was no significant difference in endothelial cell density of aPACG eyes compared with fPACG or cPACG eyes. Multivariate analysis showed the duration of the acute attack was the only factor independently associated with corneal endothelial density of aPACG eyes. The mean central corneal thickness of aPACG (549±32 μm) did not differ significantly from control eyes (552±27 μm), cPACG (557±32 μm), and fPACG (553±31 μm) (P=0.911, 0.274, and 0.725, respectively). Corneal curvature radius of aPACG eyes was not significantly different from that of the comparison groups (all P>0.05). Corneal endothelial cell density was significantly reduced in aPACG eyes compared with normal eyes. No significant difference in endothelial cell density of aPACG eyes was noted when compared with fPACG or cPACG eyes. Corneal endothelial cell density was negatively associated with the duration of the acute attack, but was not associated with demographic and biometric characteristics. Central corneal thickness and corneal curvature radius were not associated with an earlier acute angle-closure attack.

Recovery of Corneal Hysteresis After Reduction of Intraocular Pressure in Chronic Primary Angle-Closure Glaucoma

To measure corneal hysteresis (CH) in unilateral chronic primary angle-closure glaucoma (CPACG) patients to determine if it was affected by high intraocular pressure (IOP). Prospective interventional case series. CH and Goldmann-correlated IOP (IOPg) were obtained with the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Dephew, New York, USA) and central corneal thickness (CCT) was measured by optical coherence tomography. Baseline CH, IOPg, and CCT were measured in 40 CPACG eyes and compared to the fellow eyes and 40 normal controls. Reduction of IOPg in CPACG eyes was achieved medically, followed by trabeculectomy and peripheral iridectomy. Measurements were repeated at 2 and 4 weeks posttherapy. IOPg decreased significantly from 31.55 +/- 10.48 mm Hg (mean +/- standard deviation) before therapy to 11.47 +/- 4.71 mm Hg, and CH increased significantly from 6.83 +/- 2.08 mm Hg to 9.22 +/- 1.80 mm Hg at 2 weeks, with no further changes after that. However, the CH in the treated eyes remained significantly lower compared with that of fellow and normal eyes. Before treatment, CH was negatively correlated with IOPg; however, there was no correlation after treatment. CCT was not affected by the reduced IOPg in the CPACG eyes. CH was significantly lower in CPACG patients, and partial recovery occurred after successful IOP-lowering therapy. Alternations affecting corneal biomechanical properties appear to occur during glaucoma development.

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.

Long-Term Intraocular Pressure Fluctuation and Visual Field Progression in Glaucoma Patients with Low Intraocular Pressure After Post-Trabeculectomy Phacoemulsification

The aim of this study was to evaluate the association of long-term intraocular pressure (IOP) fluctuation and visual field progression in glaucoma patients with low IOP after post-trabeculectomy phacoemulsification. A total of 688 eyes with primary open-angle glaucoma (POAG) and chronic primary angle-closure glaucoma (CPACG) were included in this study. The patients always had an IOP below 18 mmHg after post-trabeculectomy phacoemulsification. Visual field testing using the standard automated perimetry was periodically performed at 3 months and for at least 3 years postoperatively. The mean deviation on visual field was compared according to the standard deviation (SD) of the postoperative IOP (SD < or = 2 mmHg group vs. SD > 2 mmHg group). Preoperative and postoperative IOPs during the follow-up period did not differ significantly between the two study groups. Even though the mean deviations on visual field at postoperative 3 months were not different between the two groups, the mean deviations at the last follow-up were significantly worse in the postoperative IOP SD > 2 mmHg group than the postoperative IOP SD < or = 2 mmHg group. Less postoperative IOP fluctuation was statistically associated with a slower progression of visual field damage in POAG and CPACG patients who kept low IOPs after the post-trabeculectomy phacoemulsification.

Long-Term Intraocular Pressure Control of Trabeculectomy and Triple Procedure in Primary Open Angle Glaucoma and Chronic Primary Angle Closure Glaucoma

To evaluate the long-term intraocular pressure (IOP) control of trabeculectomy and triple procedure (cataract extraction by phacoemulsification, intraocular lens implantation and trabeculectomy), 1,542 eyes of 900 patients with primary open angle glaucoma (POAG) or chronic primary angle closure glaucoma (CPACG) were included. When success was defined as an IOP reduction of at least 30% from baseline, with or without antiglaucoma medications, the overall probability of success of trabeculectomy and triple procedure was 0.613 and 0.733 at 15 years, respectively. The success probability of trabeculectomy and triple procedure in reducing IOP below 18 mm Hg was 0.748 and 0.825 at 15 years, respectively. In POAG and CPACG patients, trabeculectomy and triple procedure were effective in reducing IOP for up to 15 years after surgery.

Corneal endothelial status in the subtypes of primary angle closure glaucoma

To study the corneal endothelium and pachymetry in eyes with different subtypes of primary angle closure glaucoma (PACG), as compared to controls. A cross-sectional study was conducted on 30 consecutive patients in each subtype of PACG, subacute, acute and chronic, and 30 age and refraction matched controls. The parameters recorded included gonioscopy, optic disc evaluation, applanation tonometry, specular microscopy and central ultrasonic pachymetry. The mean endothelial cell counts in the four groups were as follows: subacute PACG 2396 +/- 271 cells/mm2, acute PACG 1597 +/- 653 cells/mm2, chronic PACG 2229 +/- 655 cells/mm2 and controls 2461 +/- 321 cells/mm2. The mean endothelial cell count in the fellow eyes of subacute PACG, acute PACG and chronic PACG patients was 2294 +/- 305 cells/mm2, 2388 +/- 226 cells/mm2 and 2108 +/- 203 cells/mm2, respectively (NS). The acute PACG patients had significantly lower endothelial cell counts (P < 0.001) as compared to the other three groups. Eyes in which the acute attack of angle closure persisted for less than 72 h had a mean endothelial cell count of 2016 +/- 306 cells/mm2, as compared to 759 +/- 94.4 cells/mm2 in eyes with an attack lasting for 72 h or more (P < 0.001). The endothelial count was also significantly lower in eyes with chronic PACG as compared to control eyes (P < 0.001). There was increased pleomorphism and polymegathism of the corneal endothelial cells seen in eyes with resolved acute and chronic PACG. The mean central corneal thickness was 531.4 +/- 25.3 microm in eyes with subacute PACG, 567.9 +/- 37.3 microm in eyes with acute PACG, 526.4 +/- 31.9 microm in eyes with chronic PACG and 525 +/- 12.6 microm in control eyes. The acute PACG eyes had a significantly higher corneal thickness (P < 0.001) when compared to all the other groups. There is a significant decrease in the corneal endothelial cell density in eyes that have had an acute attack of angle closure glaucoma and in eyes with chronic PACG. The endothelial cell population in eyes with sub-acute PACG and in the fellow eyes of all subtypes of PACG is not significantly different from the normal population.

Synechial Angle Closure Pattern in Chinese Chronic Primary Angle-closure Glaucoma Patients

The aim of this retrospective clinical study is to investigate the pattern of synechial angle closure in a group of Hong Kong Chinese with chronic primary angle-closure glaucoma. The anterior angle of the upper, lower, medial, and lateral quadrants of 84 eyes from Hong Kong Chinese patients with chronic primary angle-closure glaucoma were assessed by the same examiner using indentation gonioscopy. The incidences of synechial angle closure at the superior, nasal, inferior, and temporal quadrants were 98% (83/84), 77% (65/84), 31% (26/84), and 94% (79/84), respectively. The Fisher exact test showed that the incidence of synechial angle closure at the superior quadrant was significantly higher than the nasal (P = 0.005) and inferior (P < 0.001) quadrants, but not the temporal quadrant (P = 0.07). Synechial angle closure is circumferential with asymmetry in these Chinese patients with chronic primary angle-closure glaucoma. The superior and temporal quadrants of the anterior angle may be the earliest sites of the synechial angle closure. The anterior angle may close synechially at the superior and temporal quadrants with gradual extension on the nasal quadrant, until the angle may close at the inferior quadrant.