July 2019
Volume 60, Issue 9
Open Access
ARVO Annual Meeting Abstract  |   July 2019
The incidence of acute angle-closure attack in primary angle closure suspect after pharmacologic mydriasis: A randomized controlled trial
Author Affiliations & Notes
  • David S Friedman
    Ophthalmology, Johns Hopkins Wilmer Eye Inst, Dana Center , Baltimore, Maryland, United States
  • Dolly Shuo-Teh Chang
    Ophthalmology, Johns Hopkins Wilmer Eye Inst, Dana Center , Baltimore, Maryland, United States
  • Paul J Foster
    NIHR Biomedical Research Centre, Moorfields Eye Hospital, London, United Kingdom
  • Beatriz Munoz
    Ophthalmology, Johns Hopkins Wilmer Eye Inst, Dana Center , Baltimore, Maryland, United States
  • Tin Aung
    Singapore National Eye Center, Singapore
  • Mingguang He
    Zhongshan Ophthalmic Center, Gunagzhou, China
  • Footnotes
    Commercial Relationships   David Friedman, None; Dolly Chang, None; Paul Foster, None; Beatriz Munoz, None; Tin Aung, None; Mingguang He, None
  • Footnotes
    Support  This work is supported by the Fight for Sight (grant no. 1655) (United Kingdom), the Sun 483 Yat-sen University 5010 Project Fund (grant no. 2007033) (China), the National Natural 25 Science Foundation of China ( 484 grant no. 81420108008) (China) and Fundamental Research 485 Funds of the State Key Laboratory in Ophthalmology (China). Prof He receives support from 486 the University of Melbourne Research at Melbourne Accelerator Program Professorship. The 487 Centre for Eye Research Australia receives operational infrastructural support from the 488 Victorian government. Dr Jiang and Prof Foster supported by a grant from the British 489 Council for Prevention of Blindness (UK). Prof Foster received additional support from the 490 National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields 491 Eye Hospital, London, United Kingdom (NIHR-BRC2 009; Moorfields/UCL-IOO), Special 492 Trustees of Moorfields Eye Hospital (since renamed Moorfields Eye Charity) and the Richard 493 Desmond Charitable Foundation (via Fight for Sight UK).
Investigative Ophthalmology & Visual Science July 2019, Vol.60, 2823. doi:https://doi.org/
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      David S Friedman, Dolly Shuo-Teh Chang, Paul J Foster, Beatriz Munoz, Tin Aung, Mingguang He; The incidence of acute angle-closure attack in primary angle closure suspect after pharmacologic mydriasis: A randomized controlled trial. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2823. doi: https://doi.org/.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : To study the incidence of acute angle closure (AAC) secondary to dilation in primary angle closure suspect (PACS).

Methods : In this randomized controlled trial, 11,991 participants aged between 50 and 70 years were screened in the community from Guangzhou, China. People with bilateral PACS (defined as 180° or more angle closure without peripheral anterior synechiae or elevated intraocular pressure) were enrolled and received LPI in one randomly selected eye with the fellow remaining untreated. Tropicamide 0.5% and phenylephrine 5% were used to dilate the pupil at baseline and each follow up visit (2 weeks, 6, 18, 36, 54, and 72 months). Subjects who developed a post-dilation IOP > 30 mmHg were given 250 mg of acetazolamide and a drop of brimonidine.

Results : Of the 889 subjects (1778 eyes) who underwent randomization, four eyes developed AAC after dilation; 1 bilateral AAC at the 2-week evaluation, 1 untreated eye at 54-month, and 1 untreated eye at 72 months. The incidence was 5.7/10,000 eye-year in untreated eyes versus 1.9/10,000 in LPI-treated eyes (p=0.363). The risk of acute attack was less than one per 1000 times of dilation in untreated eyes. All AAC patients were treated medically with resolution of the attack and LPI was performed in untreated eyes after AAC. No serious vision loss was observed.

Conclusions : The incidence of AAC after dilation in this high-risk group was low. LPI provided a protective effect but did not completely eliminate the risk of AAC.

This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.

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