Changes in Intraocular Pressure and Angle Structure after Dilation in Primary Angle-Closure Suspects with Visually...

Area of Science:

• Ophthalmology
• Anterior Segment Imaging
• Glaucoma Research

Background:

• Primary angle-closure suspects (PACS) with visually significant cataract (VSC) present a unique clinical challenge.
• Evaluating pupillary dilation safety is crucial to avoid exacerbating angle closure or increasing intraocular pressure (IOP).

Purpose of the Study:

• To assess the safety of pupillary dilation in PACS patients with VSC.
• To identify risk factors for elevated IOP post-dilation.
• To describe anterior segment anatomical changes following dilation.

Main Methods:

• Prospective study involving 78 eyes of patients with PACS and VSC.
• Pupillary dilation using tropicamide and phenylephrine hydrochloride.
• Pre- and post-dilation measurements of IOP and anterior segment anatomy via swept-source OCT (SS-OCT) at 1, 4, and 6 hours.

Main Results:

• Mean IOP showed a minimal, non-significant increase post-dilation.
• A small percentage of patients experienced minor IOP elevations (≥5 mmHg or ≥8 mmHg).
• No cases of acute primary angle-closure were observed; anterior chamber depth increased, negatively correlating with IOP elevation.

Conclusions:

• Pupillary dilation in this cohort of PACS with VSC appears safe with a low risk of significant IOP spikes.
• Observed anatomical changes, including ciliary muscle relaxation and anterior chamber deepening, may mitigate IOP elevation.
• Further research can explore the mechanisms behind these adaptive changes.