Study of Structural and Functional Changes in Early Acute Primary Angle-closure Glaucoma

1. Cai Yu
2. Chen xiang-yu
3. Pan ying-zi
4. Li Mei
5. Qiao rong-hua
6. Fang yuan
7. Yan xiao-ming

Department of Ophthalmology,Peking University First Hospital

Background: To investigate fundus structural changes and visual field defects after first attack of acute primary angle-closure glaucoma (APACG) in Chinese patients, which may help better understanding definition of APACG.

Methods: This is a prospective, pilot study. Eleven patients who underwent first attack of unilaterally APACG were enrolled. IOP was controlled to normal. RTVue OCT, Frequency doubling perimetry (FDP) and Humphrey visual field(HVF) were performed at 2 weeks,1 month,2 months and 3 months after attack. Optic disc, retinal nerve fiber layer thickness (RNFLT), macular ganglion cell complex (MGCC) , light sensitivity(LS), MD, and PSD of attacked eyes were analyzed longitudinally.

Results:
1.Temporal superior and inferior RNFLT of the affected eyes were thicker, then became thinner longitudinally（P＜0.05）.2.Cup area, cup disc ratio and cup disc area ratio decreased at 2 weeks(p＜0.05),then recovered and were stable at 1 month till the end of study(p＞0.05).3.Total, superior and inferior average thickness of MGCC became thinner within 2 months(p＜0.05), and back to normal at 3 months(p＞0.05). 4.Superior arcuate and nasal LS of FDP were significantly decreased at 2 weeks (P＜0.05), increased and remained stable after 1 or 2 month,respectively. LS of nasal area of HVF was as same result as FDP. A good correlation was found between MD from FDP and HVF at both 2 weeks（r=0.923，p=0.000） and 3 months（r=0.752，p=0.008）.

Conclusion: After an attack of APACG, superior and inferior temporal RNFLT were found decreasing initially. Structure of the optic nerve head was relatively stable. MGCC became thinner in the first 2 months and then recovered at 3 months. Visual field defects were more likely distributed in superior arcuate and nasal areas in the early stage, similarly to POAG. These detections provide useful information about the structural and functional changes in Chinese APACG patients and offer a better guide to assess these patients.