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

Main Article Content

Dr. Leena
Dr. K. Mohan
Dr. M.R. Chitra
Dr J. Jayalatha

Keywords

Acute Angle-Closure Glaucoma, Incidence, Intra Ocular Pressure, Visual Acuity

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.

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References

1. Quigley HA, Broman AT. The number of people with glaucoma worldwide in 2010 and 2020. Br J Ophthalmol 2006;90(3):262-7.
2. Hillman JS. Acute closed-angle glaucoma: an investigation into the effect of delay in treatment. Br J Ophthalmol 1979;63(12):817-21.
3. Bonomi L, Marchini G, Marraffa M, et al. Epidemiology of angle-closure glaucoma: prevalence, clinical types, and association with peripheral anterior chamber depth in the Egna-Neumarket Glaucoma Study. Ophthalmology 2000;107(5):998-1003.
4. David R, Tessler Z, Yassur Y. Epidemiology of acute angle-closure glaucoma: incidence and seasonal variations. Ophthalmologica 1985;191(1):4-7
5. Ng WS, Ang GS, Azuara-Blanco A. Primary angle closure glaucoma: a descriptive study in ScottishCaucasians. Clin Exp Ophthalmol 2008;36(9):847-51.
6. Teikari J, Raivio I, Nurminen M. Incidence of acute glaucoma in Finland from 1973 to 1982. Graefes Arch Clin Exp Ophthalmol 1987;225:357-60.
7. Melanie M, Nataliya D, Sabrina V, et al. Acute primary angle closure glaucoma prognostic factors. JOJ Ophthalmol 2021;8(5):555750.
8. Lai JS, Liu DT, Tham CC, et al. Epidemiology of acute primary angle-closure glaucoma in the Hong Kong Chinese population: prospective study. Hong Kong Med J 2001;7(2):118-23.
9. Bojić L, Mandić Z, Ivanisević M, et al. Incidence of acute angle-closure glaucoma in Dalmatia, southern Croatia. Croat Med J 2004;45(3):279-82.
10. Das J, Bhomaj S, Chaudhuri Z, et al. Profile of glaucoma in a major eye hospital in north India. Indian J Ophthalmol 2001;49(1):25-30.
11. Day AC, Foster PJ. Increases in rates of both laser peripheral iridotomy and phacoemulsification have accompanied a fall in acute angle closure rates in the UK. Br J Ophthalmol 2011;95:1339-40.
12. Gillan SN, Wilson PJ, Knight DS, et al. Trends in Acute Primary Angle-Closure Glaucoma, Peripheral Iridotomy and Cataract Surgery in Scotland, 1998-2012. Ophthalmic Epidemiol 2016;23(1):1-5.
13. Seah SK, Foster PJ, Chew PT, et al. Incidence of acute primary angle-closure glaucoma in Singapore. An island-wide survey. Arch Ophthalmol 1997;115(11):1436-40.
14. Lai JS, Liu DT, Tham CC, et al. Epidemiology of acute primary angle-closure glaucoma in the Hong Kong Chinese population: prospective study. Hong Kong Med J 2001;7(2):118-23.
15. Douglas GR, Drance SM, Schulzer M. The visual field and nerve head in angle-closure glaucoma: a comparison of the effects of acute and chronic angle closure. Arch Ophthalmol 1975;93(6):409-11.
16. Quigley HA, Addicks EM. Chronic experimental glaucoma in primates. II. Effect of extended intraocular pressure elevation on optic nerve head and axonal transport. Invest Ophthalmol Vis Sci 1980;19(2):137-52.
17. Shen SY, Baskaran M, Fong AC, et al. Changes in the optic disc after acute primary angle closure. Ophthalmology 2006;113(6):924-9.
18. George R, Paul PG, Baskaran M, et al. Ocular biometry in occludable angles and angle closure glaucoma: a population based survey. Br J Ophthalmol 2003;87(4):399-402.
19. Sihota R, Agarwal HC. Profile of the subtypes of angle closure glaucoma in a tertiary hospital in north India. Indian J Ophthalmol 1998;46(1):25-9.
20. Das J, Bhomaj S, Chaudhuri Z, et al. Profile of glaucoma in a major eye hospital in north India. Indian J Ophthalmol 2001;49(1):25-30.
21. Chua PY, Day AC, Lai K, et al. The incidence of acute angle closure in Scotland: a prospective surveillance study. Br J Ophthalmol 2018;102(4):539-43.
22. Patel KH, Javitt JC, Tielsch JM, et al. Incidence of acute angle‐closure glaucoma after pharmacologic mydriasis. Am J Ophthalmol 1995;120(6):709‐17.
23. Lagan MA, O'Gallagher MK, Johnston SE, et al. Angle closure glaucoma in the Northern Ireland Diabetic Retinopathy Screening Programme. Eye (Lond) 2016;30(8):1091‐3.
24. Tan AM, Loon SC, Chew PT. Outcomes following acute primary angle closure in an Asian population. Clin Experiment Ophthalmol 2009;37(5):467-72.
25. Tan AM, Loon SC, Chew PTK. Outcomes following acute primary angle closure in an Asian population. Clin Exp Ophthalmol 2009;37(5):467-72.
26. Lowe RF. Primary angle-closure glaucoma: a review 5 years after bilateral surgery. Br J Ophthalmol 1973;57(7):457-63.
27. Lee JWY, Wong BKT, Yick DWF, et al. Primary acute angle closure: Long-term clinical outcomes over a 10-year period in the Chinese population. Int Ophthalmol 2014;34(2):165-9.