Progression in Primary Angle Closure Eyes

Purpose: To study the long-term course of primary angle closure (PAC) eyes after iridotomy. Methods: Seventy-two eyes of 72 patients diagnosed as PAC, having occludable angles with evidence of closure, but no ocular hypertension, were studied. Laser iridotomy was carried out in all eyes at baseline. Standard achromatic perimetry and tonometry were recorded at baseline and serially every 6 months, for at least 4 years. Changes on perimetry and the intraocular pressure (IOP) were analyzed. Results: At 1 year, 10 eyes and at final review, 26 eyes had developed ocular hypertension and required topical antiglaucoma medication. Eight eyes developed visual field defects on standard achromatic perimetry, over a mean period of 6.89 +/- 2.4 years. Eyes that progressed on perimetry, had a significantly narrower angle recess, less than or equal to 10 degrees, P - 0.04, and a higher baseline MD and PSD, P = 0.004 and 0.03, respectively. They also showed having a larger intervisit IOP fluctuation of 8.9 +/- 2.3mm Hg, cf stable eyes, 6.2 +/- 3mm Hg, P - 0.003, and a longer duration of follow-up, P = 0.01. Conclusion: A third of PAC eyes, with very narrow angles, higher global indices, intervisit IOP fluctuations, and a longer duration of follow-up were observed to develop ocular hypertension. A third of the PAC eyes with hypertension, that is 11.1% overall, went on to develop PAC glaucoma.