Predictors of Glaucoma Progression After Acute Primary Angle Closure

In acute primary angle closure, early cataract extraction is protective against glaucomatous progression through better IOP control, while higher mean IOP and worse baseline visual field defects are associated with increased risk.

To evaluate long-term outcomes and identify risk factors for glaucomatous optic neuropathy (GON) progression after acute primary angle closure (APAC).

In this multicenter retrospective cohort study, we enrolled 156 eyes from 130 APAC patients with ≥2 years of follow-up. Baseline clinical features, including visual field mean deviation (VFMD) and optical coherence tomography (OCT) parameters, as well as follow-up intraocular pressure (IOP) and interventions, were collected. GON progression was defined by concordant structural and functional changes. Univariate and multivariate logistic regression were used to identify risk factors.

The mean age was 63.9±9.6 years, and 71.5% of patients were female. During follow-up, 129 eyes (82.7%) underwent cataract extraction and 49 eyes (31.4%) underwent glaucoma surgery. Visual acuity, IOP, and medication burden improved (all P <0.05), whereas mean VFMD and OCT retinal nerve fiber layer (RNFL) thickness did not show a significant change. Twenty-three eyes (14.7%) were blind; 15 (9.6%) due to glaucoma alone. In multivariable analysis, higher mean follow-up IOP (aOR: 1.14 per mm Hg, P =0.005) and worse baseline VFMD (aOR: 1.07 per 1 dB worsening, P =0.048) independently predicted progression, while early cataract extraction (<3 mo) was protective (aOR: 0.43, P =0.047), an effect partly mediated through IOP reduction (indirect effect β=-0.20, 95% CI: -0.39 to -0.04).

After APAC, higher mean IOP and worse baseline VFMD are associated with GON progression. Early cataract extraction may reduce progression risk, partly through improved IOP control.