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G.S. Tan, S.–T. Hoh, R. Husain, F.T. S. Oen, G. Gazzard, S.K. L. Seah, T. Aung; Visual Acuity After Acute Primary Angle Closure– Considerations for Primary Lens Extraction . Invest. Ophthalmol. Vis. Sci. 2005;46(13):138.
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Purpose: Although primary lens extraction has been advocated for cases of acute primary angle closure (APAC), it is not known if this is warranted in all cases. The aim of this study was to investigate the visual acuity (VA) of APAC eyes shortly after resolution of the acute episode. Methods: This was an prospective observational case series. As part of a randomized controlled trial comparing phacoemulsification and laser iridotomy, 135 consecutive APAC subjects over a 2 year period underwent subjective refraction and measurement of Snellen VA once the acute episode had resolved with reduction of IOP and improved corneal clarity. Results: Subjects were predominantly Chinese (95.6%) and female (79.3%), with a mean age of 63.6 ± 9.6 years. When assessed 1.7 + 2.7 days after presentation, the majority of APAC cases (50.4%) had good VA (6/12 or better), with more than a quarter of cases having VA of 6/7.5 or better. Poor VA was associated with duration of symptoms (p=0.04, OR=4.1, CI95% 1.1–15.7) and time taken to resolution of APAC (p=0.04, OR=2.2, CI95% 1.02–4.6), but not with sex (p=0.31), age (p=0.26) or presenting IOP (p=0.73). Conclusions: Within days after APAC, more than half of APAC affected eyes had good visual acuity (6/12 or better). These results suggest that the role of lens extraction in the management of APAC, especially in eyes with good visual acuity, warrant further debate.
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