Long-term clinical course of primary angle-closure glaucoma in an Asian population

Purpose: To study the long-term clinical course of patients with primary an gle-closure glaucoma (PACG). Design: Retrospective, noncomparative, interventional case series. Participants: Sixty-five consecutive patients who were diagnosed with PACG at one Singapore hospital from January 1990 through December 1994. Methods: Primary angle-closure glaucoma was defined as the presence of glau comatous optic neuropathy and compatible visual field loss associated with a closed angle in the same eye. All study eyes underwent laser peripheral i ridotomy (LPI). There were two groups of patients studied. Group A consiste d of those with a past documented history of an episode of acute angle clos ure (that had resolved after LPI). Group B consisted of those with no previ ous acute episode. The presenting features, management, and subsequent long -term intraocular pressure (IOP) outcome were analyzed. Main Outcome Measures: Intraocular pressure and the need for further glauco ma treatment. Results: The follow-up period was 63 +/- 29 months (mean +/- standard devia tion). The mean presenting IOP was 40 +/- 16 mmHg, and the presenting verti cal cup-to-disc ratio was 0.6 +/- 0.2. Of the 83 eyes, only five eyes (6%) did not require any treatment after LPI in the long term. In group A (35 ey es), all eyes required further treatment with antiglaucoma medications. Twe nty-two eyes (62.9%) eventually underwent filtering surgery at a mean of 7. 3 months after the commencement of treatment. In group B (48 eyes), 43 eyes (89.6%) underwent further medical therapy, of which 22 eyes (45.8%) eventu ally underwent filtering surgery at a mean of 18.4 months after the commenc ement of treatment. Conclusions: Despite the presence of a patent LPI, most eyes with establish ed PAGG require further treatment to control IOP. Medical therapy fails in most cases, necessitating filtering surgery. Patients risk experiencing fur ther glaucomatous visual damage if this trend is not detected. (C) 2000 by the American Academy of Ophthalmology.