Seventeen-Year Clinical Analysis of Acute Primary Angle-Closure Glaucoma at a Single Japanese Tertiary Center

Acute primary angle-closure glaucoma (APAC) is a sight-threatening emergency that requires immediate intervention; however, there are few reports regarding its therapeutic efficacy and complications. We analyzed 17-year clinical characteristics, surgical outcomes, intraocular pressure (IOP) trajectories, visual acuity (VA), and complications in APAC at a Japanese tertiary center.

This is a retrospective, single-center, observational cohort study.

Records of 210 patients (229 eyes) with APAC between June 2009 and September 2025 were reviewed. Demographics, presenting IOP, biometric parameters, surgical procedure, VA, and postoperative complications were evaluated. IOP at baseline, postoperative day 1 (POD1), one week, one month, and three months was compared using the Wilcoxon signed-rank test with Bonferroni correction. Onset distribution was assessed using chi-square goodness-of-fit tests.

Mean age was 73.2 ± 10.0 years; 68.6% were female. Mean presenting IOP was 53.2 ± 15.4 mmHg. Initial phacoemulsification with intraocular lens implantation (PEA+IOL) was completed in 93.0% of cases. IOP decreased to 16.1 ± 9.9, 15.1 ± 7.3, 14.2 ± 4.7, and 13.9 ± 3.4 mmHg at POD1, one week, one month, and three months, respectively (all corrected p < 0.001). Mean logMAR VA improved from 1.26 ± 0.99 to 0.31 ± 0.87. Paralytic mydriasis occurred in 43.2%, and 26.6% required additional glaucoma treatment. Onset showed no significant deviation from uniform distribution monthly (p = 0.095) or seasonally (p = 0.895).

Initial PEA+IOL produced sustained IOP reduction and improved VA in Japanese patients with APAC. APAC onset was evenly distributed throughout the year. The high rates of paralytic mydriasis and additional treatment in more than one-quarter of eyes highlight the importance of long-term follow-up.