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Long-term outcomes after acute primary angle closure: case series from Moorfields Eye Hospital, UK
  1. Sana Hamid1,
  2. Francesco Matarazzo1,2,
  3. Zihan Sun3,4,
  4. Sandika Baboolal1,5,
  5. Dhakshi Muhundhakumar1,
  6. Paul J Foster3,4
  1. 1Glaucoma Department, Moorfields Eye Hospital NHS Foundation Trust, London, UK
  2. 2University of Naples “Federico II”, Naples, Italy
  3. 3NIHR Moorfields Biomedical Research Centre, London, Greater London, UK
  4. 4UCL Institute of Ophthalmology, London, UK
  5. 5James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
  1. Correspondence to Mr Francesco Matarazzo, Moorfields Eye Hospital NHS Foundation Trust, London, UK; Francesco.matarazzo{at}


Background There is limited data regarding the morbidity and progression to primary angle closure glaucoma in those presenting with acute primary angle closure (APAC) in the UK. We aim to report on the vision and intraocular pressure (IOP) outcomes and treatment required after an APAC episode and to identify any risk factors that could predict worse outcomes.

Methods A retrospective observational case series review including 117 consecutive patients (121 eyes) attending Moorfields Eye Hospital, at a tertiary referral unit in the UK, with APAC was performed.

Results Most patients (73%) had visual acuities of ≥6/12, meeting the UK driving standard, at the final follow-up. Only 15% (17 eyes) had severe visual impairment, as defined by the WHO, in the affected eye, of which 6.6% (eight eyes) were due to glaucoma. The delayed presentation was linked to a higher need for further medical treatment (OR=2.83, 95% CI 1.09 to 7.40, p=0.03). Patients who underwent phacoemulsification were at lower risk of having blindness in the affected eye (OR 0.18, 95% CI 0.05 to 0.69, p=0.01), having elevated IOP (OR 0.10, 95% CI 0.01 to 0.75, p=0.02) or requiring further medical treatment (OR 0.34, 95% CI 0.12 to 0.99, p=0.04). Older age (OR 1.26, 95% CI 1.08 to 1.48, p<0.01) was associated with worse visual outcomes.

Conclusions APAC causes low long-term visual and treatment morbidity in this largely Caucasian patient group in the UK. Phacoemulsification as a treatment may enhance visual outcomes and reduce the need for further IOP-lowering treatment.

  • Glaucoma
  • Prognosis
  • Intraocular pressure
  • Ocular Hypertension

Data availability statement

No data are available. Not applicable.

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Data availability statement

No data are available. Not applicable.

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  • Contributors SH, FM, SB and DM contributed to the design and implementation of the research, to the analysis of theresults and to the writing of the manuscript. ZS verified the analytical methods and performed the analysis. PJF contributed to the conceptualisation, validation and supervision. SH is guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.