Long-term Outcomes in Fellow Eyes after Acute Primary Angle Closure in the Contralateral Eye
Received 20 September 2005; accepted 6 February 2006.
Purpose
To determine the long-term outcome of the contralateral eye in Asian persons with a unilateral attack of acute primary angle closure (APAC).
Design
Cross-sectional observational case series.
Participants
Seventy-nine individuals who were examined from 4 to 10 years after a unilateral episode of APAC at 2 Singapore hospitals.
Methods
All subjects underwent a complete eye examination. The optic discs were graded clinically and photographically for the presence of glaucomatous optic neuropathy, and automated visual field tests were assessed for damage. All visual fields and optic nerve photographs (when available) underwent a second evaluation by a masked glaucoma specialist, who assessed whether the changes were compatible with glaucoma.
Main Outcome Measures
Glaucomatous optic neuropathy, intraocular pressure (IOP), and visual impairment (defined as best-corrected visual acuity of worse than 6/12).
Results
Ninety of 138 eligible patients (65.2%) with APAC were examined, 79 with unilateral attacks. Subjects were predominantly Chinese (n = 68; 86%). There were 54 females (68%), and mean age was 68.5±8.9 years (standard deviation) at the time of APAC, with a mean duration of 6.3±1.5 years from the time of the APAC episode to the study examination. The contralateral eyes of 7 patients (8.9%) had definite or probable glaucoma, 2 of whom were felt to have glaucoma in that eye at the time of the attack. Three eyes had markedly cupped optic discs (cup-to-disc ratio ≥ 0.9). Thirteen eyes (16.9%) had best-corrected vision worse than 6/12, due to cataract in almost half the cases. Only 1 eye had vision < 6/60, the cause of which was corneal decompensation. One other patient had only a central island remaining with vision of 6/12. Mean IOP of the study participants was 15.7±4.7 mmHg, with 6 subjects (7.6%) having undergone trabeculectomy.
Conclusions
Definite or probable glaucoma was present at the time of diagnosis in 2 (2.5%) fellow eyes and developed in an additional 5 (6.5%) with a mean follow-up of 6 years. More than 80% of this cohort retained good vision in the contralateral eye, in contrast to the eye that underwent APAC. Unoperated cataract accounted for most of the visual impairment in this group.
1Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland.
Correspondence to David S. Friedman, MD, MPH, Wilmer Eye Institute, Johns Hopkins University, 600 North Wolfe Street, Wilmer 120, Johns Hopkins Hospital, Baltimore, MD 21287.
ABSTRACT