Long-term outcomes following lens extraction surgery in acute primary angle closure

Abstract:

AIM: To investigate the long-term outcomes in acute primary angle closure (APAC) patients treated with lens extraction (LE) surgery and to identify risk factors for glaucomatous optic neuropathy (GON). METHODS: In this longitudinal observational study, detailed medical histories of APAC patients and comprehensive ophthalmic examinations at final follow-up were collected. Logistic regression analysis was performed to identify predictors of blindness. Univariate and multivariate linear regression analyses were conducted to determine risk factors associated with visual outcomes. RESULTS: This study included 39 affected eyes of 31 subjects (26 females) with an average age of 74.1±8.0y. At 6.7±4.2y after APAC attack, 2 (5.7%) eyes had best-corrected visual acuity (VA) worse than 3/60. Advanced glaucomatous visual field loss was observed in 15 (39.5%) affected eyes and 5 (25.0%) fellow eyes. Nine affected eyes (23.7%) had GON, and 11 (28.9%) were blind. Six (15.4%) affected eyes and 2 (9.1%) fellow eyes had suspicious progression. A significantly higher blindness rate in factory workers compared to office workers. Logistic regression identified that worse VA at attack (OR 10.568, 95%CI 1.288-86.695; P=0.028) and worse early postoperative VA (OR 13.214, 95%CI 1.157-150.881; P=0.038) were risk factors for blindness. Multivariate regression showed that longer duration of elevated intraocular pressure (P=0.004) and worse early postoperative VA (P=0.009) were associated with worse visual outcomes. CONCLUSION: Despite LE surgery, some APAC patients experience continued visual function deterioration. Lifelong monitoring is necessary. Target pressure and progression rates should be re-evaluated during follow-up.