A PROSPECTIVE STUDY OF THE INCIDENCE OF ACUTE ATTACK OF ANGLE CLOSURE GLAUCOMA IN PATIENTS ATTENDING GLAUCOMA CLINIC IN A TERTIARY EYE CARE HOSPITAL

Abstract

Background: Glaucoma is the leading cause of irreversible blindness. Glaucoma is a group of ocular disorders defined by optic nerve head and visual field changes characterized by increased IOP (Intra Ocular Pressures) and can result in optic neuropathy and vision loss if left untreated. Acute angle closure glaucoma is an ocular emergency that presents as a sudden onset of severe unilateral ocular pain or headache often associated with blurring of vision, a history of coloured halos around bright lights, nausea and vomiting. Data relating to the Indian population during this ocular emergency is sparse. Hence, the present study was undertaken to estimate the incidence of acute attacks of angle closure glaucoma among patients attending glaucoma clinics in a tertiary eye care hospital and to analyze the outcome of the patients after treatment.

Methods: This was a prospective study conducted among patients with acute attacks of angle closure glaucoma attending the glaucoma clinic at RIOGOH during the period March 2019-February 2020. A detailed history was obtained and all patients were subjected to measurements of initial presenting visual acuity, intraocular pressure with an iCare rebound tonometer or Goldmann applanation tonometer, anterior segment examination to look for corneal edema and shallow anterior chamber angle and posterior segment examination for optic nerve head changes using a 90D lens. Patients were followed up after starting medical, surgical, or laser iridotomy with gonioscopy for measurement of angles. They were then monitored regularly at monthly intervals. At each visit, visual acuity, anterior segment examination by slitlamp, intraocular pressure measurement by rebound tonometry and gonioscopy for angle measurement were done. Depending on the status of the angles, either trabeculectomy or lens removal for cataractous lenses was done and the patients were followed up for a period of 6 months.

Results: In the present study, the incidence of acute angle-closure glaucoma was 11.4% in patients aged less than 50 years, 37.1% in 51-60 years, 45.7% in 61-70 years, and 5.7% above 70 years. 80.0% of the study subjects were females and 20.0% were males. The majority, 51.4%, had an acute attack in the left eye and 48.6% had an acute attack in the right eye. The minimum IOT observed at presentation was 30.0 mmHg, the maximum 54.0 mmHg, with a mean of 43.7±6.8 mmHg, which was significantly higher than the normal value of 241 mmHg. The values were significantly lower at 3 and 6 months of follow-up. Axial length was found to be significantly lower than the normal value of 24mm. An improvement in the visual acuity was observed at the end of 6 months, compared to the time of presentation.

Conclusion: Acute angle-closure glaucoma represents a sight-threatening emergency necessitating swift intervention, which results in favorable outcomes.