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G. S. Tan, C.-Y. Wong, T.-Y. Wong, C. G. Vallei, E. Y. Wong, I. Y. Yeo, T. Aung; Is Routine Dilation Safe Among Asian Patients With Diabetes?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):5103. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To investigate the risk of acute angle closure (AAC), changes in intraocular pressure (IOP) and factors associated with these outcomes after routine pupil dilation in a cohort of Asian patients with diabetes mellitus.
A prospective observational case series of 1,910 consecutive new Asian patients referred for assessment of diabetic retinopathy at a tertiary diabetic retinopathy clinic in a Singapore hospital. All subjects were routinely dilated unless there was a prior history of angle closure glaucoma. Non-contact airpuff tonometry was used to assess IOP, which was measured by the same observer before and 1 hour after pupil dilation. Patients who were found to have an IOP rise of >=5 mmHg 1 hour after pupil dilation were reassessed with IOP measured by Goldmann applanation tonometry. Patients were assessed for signs and symptoms of AAC before leaving the clinic, and their charts were also subsequently reviewed for revisits with AAC.
Of the 1910 subjects who participated (mean age 63.6 ± 11.3 years, 46.6% men, 76.4% Chinese, 12.0% Malay, 10.7% Indian and 0.9% others), none of the patients developed AAC. There were 69 subjects (3.6%, 95% CI: 2.8 to 4.5%) who developed a rise in IOP of >= 5 mmHg in the either eye and 37 subjects (1.9%, 95% CI: 1.4 to 2.6%) who had a post-dilation IOP >25 mmHg in either eye. Only 10 subjects (0.5%) developed a rise in IOP >= 5 mmHg and had a post-dilation IOP >25mm Hg in either eye; none of these subjects had signs of AAC. The level of pre-dilation IOP and a known history of glaucoma were found to be significant risk factors for a post-dilation IOP >= 25 mmHg.
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