Predictors of Glaucoma Progression After Acute Primary Angle Closure

Area of Science:

• Ophthalmology
• Glaucoma Research
• Retinal Diseases

Background:

• Acute primary angle closure (APAC) can lead to glaucomatous optic neuropathy (GON).
• Understanding long-term outcomes and risk factors is crucial for managing APAC patients.
• Identifying predictors of GON progression is essential for timely intervention.

Purpose of the Study:

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

Main Methods:

• Multicenter retrospective cohort study of 156 eyes from 130 APAC patients with ≥2 years follow-up.
• Collected baseline clinical features, visual field mean deviation (VFMD), OCT parameters, intraocular pressure (IOP), and interventions.
• Defined GON progression by concordant structural and functional changes; used logistic regression to identify risk factors.

Main Results:

• Higher mean follow-up IOP and worse baseline VFMD independently predicted GON progression.
• Early cataract extraction (<3 months) was protective against progression, partly mediated by IOP reduction.
• While visual acuity and IOP improved post-intervention, VFMD and RNFL thickness showed no significant change; 14.7% of eyes became blind.

Conclusions:

• Elevated intraocular pressure and poorer baseline visual fields are key risk factors for GON progression after APAC.
• Early cataract extraction demonstrates a protective effect, potentially by improving IOP control.
• Timely surgical intervention, such as cataract extraction, may mitigate the risk of glaucomatous progression in APAC patients.