P-T-086 Comparison between recent and old acute primary angle closure cases in Brazilians for retinal nerve fiber layer damage Sebastião Cronemberger,1 Rafael Vidal Mérula, Mérula,1 Nassim Calixto Calixto,,1 Érica de Abreu Borges1 Department of Ophthalmology and Otorhinolaryngology, Otorhinolaryngology, Universidade Federal de Minas Gerais Gerais,, Belo Horizonte, Brazil; Hospital São Geraldo, Universidade Federal de Minas Gerais Gerais,, Belo Horizonte, Brazil 1
INTRODUCTION Acute primary angle closure (APAC) is an ophthalmic emergency and a potentially blinding disease. Optic nerve damage can occur after a sudden rise in intraocular pressure (IOP) associated with an APAC episode. The optic disc appears edematous during this crisis and pallor with or without cupping may develop after remission. Many studies report a poor long-term visual outcome after APAC, with high rates of severe glaucomatous optic neuropathy.1-5 Retinal nerve fibre layer (RNFL) loss,6-13 optic nerve head (ONH) damage,1416 and visual field defects17-19 have been described following APAC. However, there are few reports concerning long-term RNFL and macular thickness changes in APAC20 and none for Brazilians. Furthermore, no data is available for the comparison between eyes with recent episodes of APAC and those that had the crisis at least more than a year ago.
was 12.2 (±8.9), average corrected low variance (CLV) was 24.4 (±21.8), average total RNFL thickness was 74.5 (±43.1) µm, superior temporal RNFL was 77.7 (±35.4) µm, temporal RNFL was 51.0 (±9.2) µm, inferior temporal RNFL was 85.9 (±39.8) µm, superior nasal RNFL was 74.3 (±38.0) µm, nasal RNFL was 57.5 (±19.6) µm, inferior nasal RNFL was 67.4 (±32.5) µm. In fellow non-affected APAC eyes, average IOP at the moment of the crisis was 12.4 (±0.5) mmHg, average of central corneal thickness was 535 (±21.9) µm, average of axial length was 21.83 (±0.72) mm, average visual field MD was 7.0 (±9.0), average CLV was 26.2 (±19.0), total RNFL average thickness was 100.5 (±4.9) µm, superior temporal RNFL was 132.9 (±20.6) µm, temporal RNFL was 70.8 (±10.3) µm, inferior temporal RNFL was 144.8 (±14.9) µm, superior nasal RNFL was 108.75 (±25.2) µm, nasal RNFL was 71.8 (±15.4) µm, inferior nasal RNFL was 120.2 (±35.0) µm.
PURPOSE To compare the recent and long-term changes in peripapillary RNFL thickness between new (crisis at ≤ 1 month period) and old cases (crisis at least one year ago) of APAC eyes and to identify possible risk factors for the severity of these changes. Fellow eyes were used as controls.
METHODS This is a comparative study in which patients ≥18 years old with APAC were eligible. Patients were identified from the hospital computerized database. The study had the approval of the Ethics Committee of the Federal University of Minas Gerais and written informed consent was obtained from all patients. Patients were submitted to a clinic examination, which included an ophthalmic examination, RNFL imaging using spectral-domain optical coherence tomography (SD-OCT), ultrasound biometric assessment, and automated perimetry by means of Octopus 1-2-3 (Haag-Streit AG, Koeniz, Switzerland). New cases of APAC eyes (crisis at ≤ 1 month period) were compared with old cases (crisis at least one year ago) of APAC eyes, and the fellow eyes were used as controls. The statistical analysis was descriptive.
Figure 1a. (Left) SD-OCT image showing an increase of the RNFL thickness in all quadrants of the APAC affected right eye of a patient 10 days after IOP normalization. (Right) SD-OCT of the non-affected eye.
DISCUSSION As far as we are aware, this is the first study to investigate and compare changes in the RNFL thickness within the ≤1 month period after an APAC episode (new APAC cases) with old cases of APAC eyes (crisis at least one year ago). We believe the increase in the RNFL thickness in all quadrants in the new APAC eyes occurs rapidly due to neuronal damage caused by an acute presentation of the disease associated with an extremely high IOP.13 In the old APAC cases in which the IOP was normalized, there was a reduction of the RNFL thickness mainly in the superior and inferior quadrants that corresponded to the increase of RNFL seen in the new APAC cases. We noticed in the new APAC eyes a diffuse visual field loss (Fig. 1b) that occurred as early as 10 days after the IOP normalization. An important point of the present study is that the visual field test was performed on the same day of the SD-OCT examination, providing an exact correlation between functional and structural changes in the patients studied.
CONCLUSIONS Newly affected APAC eyes had an increase of RNFL thickness probably due to an edematous phase just after the attack. The old APAC eyes had retained structural (RNFL loss) and functional (visual field defects) damage many years after the crisis. Our results are limited because of the small number of cases.
REFERENCES
RESULTS Ten patients with new APAC crisis and nine patients with old attack APAC were enrolled. In the new affected APAC eyes, average IOP at the moment of the crisis was 51.9 (±8.2) mmHg, average spherical equivalent was +2.15 (±1.91), average of central corneal thickness was 530 (±49.8) µm, average anterior chamber depth was 2.20 (±0.14) mm, average of axial length was 21.57 (±0.89) mm, average visual field mean defect (MD) was 6.5 (±6.7), average corrected low variance (CLV) was 18.5 (±15.5), average total RNFL thickness was 100.7 (±46.5) µm, superior temporal RNFL was 139.8 (±57.0) µm, temporal RNFL was 72.7 (±16.2) µm, inferior temporal RNFL was 161.4 (±57.3) µm, superior nasal RNFL was 126.7 (±60.3) µm, nasal RNFL was 83.4 (±25.3) µm, inferior nasal RNFL was 130.7 (±76.8) µm (Figs. 1a and 1b). In the nine old APAC cases the crisis occurred from 1 to 23 years (7.2±6.9 years) ago (Figs. 2a and 2b). The new APAC cases (80% women, 60% white) had mean age of 63.9 (±9.2) years, 100% had bilateral iridectomy, average time between the beginning of the symptoms and the lowering of intraocular pressure of 21.02 (±12.9) hours. The old APAC cases (67% women, 77.8% white) had mean age of 67.9 (±8.7) years, 100% had bilateral iridectomy, average time between the beginning of the symptoms and the lowering of intraocular pressure (IOP) of 58.8 (±105.5) hours (Fig. 2a and 2b). In the old affected APAC eyes, average IOP at the moment of the crisis was 49.7 (±8.3) mmHg, average of central corneal thickness was 538 (±26.3) µm, average of axial length was 21.79 (±0.79) mm, average visual field mean defect (MD)
Figure 2b. (Left) Normal visual field of the non-affected right eye; (Right) Visual field loss of the APAC affected left eye of a patient 23 years and 74 months after IOP normalization.
Figure 1b. (Left) Visual field loss of the APAC affected right eye of a patient 10 days after IOP normalization. (Rigth) Normal visual field of the nonaffected contralateral eye.
Figure 2a. (Left) SD-OCT image of the non-affected eye; (Right) SD-OCT image of the APAC affected left eye of a patient 23 years and 74 months after the APAC episode.
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