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Jung Min Lee, Rachel Mogil, Andrew Tirsi, Celso Tello, Sung Chul Park; Prevalence and clinical implications of anatomically narrow angles in exfoliation glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):2620. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
To revisit the association between exfoliation glaucoma and narrow angles in a large sample size.
Extensive chart review was performed for patients who visited the authors’ tertiary glaucoma referral practice from July 1, 2014 to September 30, 2014. Patients with exfoliation glaucoma in both eyes were included. Gonioscopy findings (Shaffer’s angle grade and peripheral anterior synechiae [PAS]) and history of laser iridotomy (LI) were recorded from patients’ initial exam. Humphrey 24-2 SITA-standard visual field (VF) mean deviation (MD) within 3 months from the initial exam was also recorded. The prevalence of LI, narrow angles (grade 1 or less), and PAS was calculated among patients and eyes. The prevalence of LI, narrow angles, and PAS was compared between 1) phakic and pseudophakic eyes, and 2) worse and better eye (Chi-square test): One eye was designated as the worse eye if there was a VF MD difference ≥ 2 decibels between eyes. Mean VF MD was compared between eyes with and without 1) LI, 2) narrow angles, and 3) PAS (independent t-test).
Among 2501 patients whose charts were reviewed, 144 with exfoliation glaucoma were included for analysis. 33 patients (22.6%) had ‘LI or narrow angles or PAS.’ 24 patients (16.4%) had LIs, 13 patients (8.9%) had narrow angles, and 9 patients (6.1%) had PAS. Of the 288 eyes with exfoliation glaucoma, 56 eyes (19.4%) had ‘LI or narrow angles or PAS.' 42 eyes (14.5%) had LIs, 23 eyes (7.9%) had narrow angles, and 15 eyes (5.2%) had PAS. There was no difference in the prevalence of ‘LI or narrow angles or PAS’ between 1) phakic and pseudophakic eyes, and 2) worse and better eye (all p > 0.1). VF MD was similar between eyes with and without 1) LI, 2) narrow angles, 3) PAS and 4) ‘LI or narrow angles or PAS’ (all p > 0.08).
Exfoliation glaucoma should be considered a mixed-mechanism glaucoma in many patients, not purely a secondary open-angle glaucoma, because narrow angles are not uncommon. Clinicians should monitor these patients for narrow angle progression, PAS formation, and risk of angle closure and intervene with LI, peripheral iridoplasty, miotic agents or cataract extraction as necessary. Future studies are needed to investigate whether narrow angles affect progression of exfoliation glaucoma.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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