Clinical course and outcome of primary acute angle-closure glaucoma in Singapore

Data is lacking with regard to the factors which may predict the outcome of an acute glaucoma eye to treatment and its long-term prognosis. This study was carried out to identify such factors, in particular among Singaporeans.

Fifty-seven eyes were included in this retrospective analysis and factors analysed included age and sex; the duration of onset of symptoms to the time they presented to hospital; state of pupil and presenting intraocular pressure (IOP); whether attack is terminated by medical treatment alone or a second procedure (eg laser, trabeculectomy) was required; final outcome with respect to the development of chronic angle closure glaucoma and state of pupil at last follow-up.

Patients with 24 to 72 hours' delay in presentation had a relative risk of 2.78 (CI = 1.03-7.46) in developing chronic glaucoma. Those who required the addition of a laser procedure to control the initial presenting IOP while those who proceeded to a trabeculectomy had relative risks of 3.63 (CI = 1.49-8.89) and 4.83 (CI = 1.18-19.7) respectively in developing chronic glaucoma when compared to patients who did not require any secondary treatment.

Delay in presentation, and unresponsiveness to medical treatment in termination of the acute attack in an acute angle closure glaucoma patient carry a significant risk of chronic glaucoma.