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Visual acuity after acute primary angle closure and considerations for primary lens extraction
  1. G S W Tan1,
  2. S-T Hoh1,
  3. R Husain1,2,
  4. G Gazzard1,2,
  5. F T S Oen1,
  6. S K L Seah1,
  7. T Aung1,3
  1. 1Singapore National Eye Centre, Singapore
  2. 2Institute of Ophthalmology, London, UK
  3. 3National University of Singapore, Singapore
  1. Correspondence to: Dr Tin Aung Glaucoma Department, Singapore National Eye Centre, 11 Third Hospital Avenue, Singapore 168751: tin11{at}pacific.net.sg

Abstract

Background/aim: Primary lens extraction has been advocated for acute primary angle closure (APAC), but 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 in order to assess the appropriateness of performing such surgery in this condition.

Methods: This was a prospective observational case series. As part of a randomised 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 intraocular pressure (IOP) and improved corneal clarity.

Results: Subjects were predominantly Chinese (95.6%) and female (79.3%), with a mean age of 63.6 (SD 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, 95% CI 1.1 to 15.7) and time taken to resolution of APAC (p = 0.04, OR = 2.2, 95% CI 1.02 to 4.6), but not with sex (p = 0.31), age (p = 0.26), duration from presentation to measurement of visual acuity (p = 0.53), or presenting IOP (p = 0.73).

Conclusion: Within days after APAC, more than half of APAC affected eyes had good VA (6/12 or better). The role of lens extraction in the management of APAC warrants further debate, especially for eyes with good VA.

  • APAC, acute primary angle closure
  • IOP, intraocular pressure
  • LPI, laser peripheral iridotomy
  • VA, visual acuity
  • visual acuity
  • primary angle closure
  • intraocular pressure
  • lens extraction
  • APAC, acute primary angle closure
  • IOP, intraocular pressure
  • LPI, laser peripheral iridotomy
  • VA, visual acuity
  • visual acuity
  • primary angle closure
  • intraocular pressure
  • lens extraction
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Footnotes

  • This study was supported by grants from the Singapore Eye Research Institute and Singhealth Group, Singapore.

  • Commercial interest: The authors have no financial or other conflict of interest with regard to the paper.

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