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Editors Selection IGR 13-1

Clinical Forms of Glaucoma: CDR after acute PACG

Comment by Daniel Grigera on:

27685 Acute primary angle closure attack does not cause an increased cup-to-disc ratio, Chew SS; Vasudevan S; Patel HY et al., Ophthalmology, 2011; 118: 254-159

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Does increased cup-to-disc ratio and retinal nerve fiber layer loss occur after acute primary angle closure (APAC)? This is the question Chew et al. (249) have addressed in this prospective, observational case series They assessed, by means of HRT, Stratus OCT of the RNFL and macula, and automated perimetry, the affected and the fellow eyes of twenty individuals with unilateral APAC over a twelve-month period. Measurements were done at two weeks; two to three months; and six to twelve months after the initial visit. Patients were treated within 48 hours of their arrival and the duration of symptoms experienced before consultation was recorded. There was no significant change in any of the ONH parameters as measured by HRT in affected eyes and also no significant difference in any ONH parameters between affected and fellow eyes at any time point. A significant decrease in both the superior and inferior quadrant RNFL thickness was observed, a finding consistent with previous evidence. This study suggests that an increased CDR does not occur after a single episode of APAC, provided that treatment is administered promptly after the onset of the attack. It also brings to our attention the changes in RNFL thickness in the inferior and superior quadrants in such patients. As mentioned by the authors, a limitation of the study, is that the sample size might have been too small to identify small changes in the parameters analyzed.

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