Acute primary angle closure in Thailand

Aim: To evaluate the clinical presentation, progression, and treatment outcome after acute primary angle closure in Thai patients. Methods: This was a retrospective study of 68 eyes of 66 consecutive patients with acute primary angle closure presenting to the Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand, from 2000 to 2002. Acute angle closure from secondary causes was excluded. The predictive factors for the need for filtration surgery were studied. Results: There were 15 men and 51 women with a mean age of 60.5 years (range, 35 to 81 years). The mean intraocular pressure at presentation was 58.2 mm Hg (SD, 14.3 mm Hg). After initial treatment with antiglaucoma medications, all eyes underwent laser peripheral iridotomy. Three eyes needed additional surgical peripheral iridotomy. The intraocular pressure of 45 eyes (66.2%) was successfully controlled at <21 mm Hg without further intervention. Of the 45 eyes, only 7 (15.5%) required no antiglaucoma medication at discharge. The remaining 23 eyes (33.83%) underwent filtration surgery. The filtration surgery group had a mean duration of symptoms significantly longer than that of the non-filtration surgery group (p < 0.05) and a significantly greater mean pupil size within 24 hours of the initial treatments (p < 0.05). Conclusion: Prompt diagnosis and early treatment for acute primary angle closure is important to prevent subsequent morbidity. Laser peripheral iridotomy and medications can control acute episodes of angle closure and its sequelae for most patients, with one-third requiring surgical intervention for control of intraocular pressure.