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Laura Dallorto, Carlo Lavia, Giulia Consolandi, Giulia Pignata, Teresa Rolle, Antonio Maria Fea; Long-term outcomes in an Italian APAC cohort of patients. Invest. Ophthalmol. Vis. Sci. 2017;58(8):3740.
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© ARVO (1962-2015); The Authors (2016-present)
Primary Angle Closure Glaucoma (PACG) is a common cause of blindness worldwide and Acute Primary Angle Closure (APAC) is one of its leading causes. Few studies report long term prognosis of PACG following APAC, especially in Caucasians. This observational study reports the incidence of APAC in a Caucasian population and provides morphological and functional assessment in patients who developed PACG after a long-term follow-up.
5-years incidence estimates of APAC in Piedmont (north-west Italy) were performed and patients’ gender, age, hospitalization rate and clinical management were collected. Consecutive patients with PACG after an APAC attack underwent a complete ophthalmic examination, best corrected visual acuity (BCVA), Standard Automated perimetry (SAP; 24-2 Humphrey Field Analyzer; Carl Zeiss), ultrasound corneal pachymetry, corneal endothelial cell density (ECD, CellCheck Specular Microscope, Konan), axial length measurement (IOL Master, Carl Zeiss), peripapillary and macular imaging (OCT, RTVue-100, Optovue). APAC and fellow eyes measurements were compared using a Wilcoxon signed-rank test.
Piedmont has a population of about 4 million people. APAC incidence was mainly constant in the 5 years analyzed and was approximately 3.38/100000 per year. 70 patients were analyzed 5.9±1.4 years after APAC (range 5-9 years). Mean APAC IOP was 53±8.8mmHg. APAC resolved in 22±17.8 hours with a mean of 2.7±0.6 topical medications and 1.1±0.8 systemic drugs. 26 (37%) and 40 eyes (57%) underwent immediate or deferred laser iridotomy. Mean IOP at follow-up was respectively 13.6±2.8 and 13.8±2.6 mmHg in affected and fellow eyes (p=0.47). Mean time to phacoemulsification was 38.7±13.1 and 45.1±11.1 months in affected and fellow eyes (p=0.07). No additional glaucoma surgery was necessary in all eyes. Significant changes between respectively affected and fellow eyes were observed in terms of BCVA (0.28±0.31 vs 0.16±0.18 LogMAR, p<0.001), SAP (MD=4.60±3.56 vs 3.20±2.53dB, p<0.001), OCT (RNFL average=91.86±14.65 vs 98.15±15.30μm, p<0.001), ECD (1894.6±505.3 and 2051.4±413.5 cells/mm2, p=0.001).
PACG after APAC in affected eyes was significantly more severe than in fellow eyes, considering both anatomical and functional parameters. Nevertheless, fellow eyes showed a certain degree of damage and their monitoring is recommended. APAC in Caucasians is relatively common, even if its incidence is lower than in East Asians.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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