Objective Assessment of Progression after Acute Primary Angle Closure Using HRT and GDx

Abstract

Irreversible damage to the optic nerve can follow the rapid increase of IOP during an acute primary angle closure (APAC). Despite the development of advanced imaging technology, there is still a lack of good longitudinal studies assessing patients after an acute attack. The aim of this study was to assess the progression of patients using different objective optic nerve head and retinal imaging parameters following APAC.Twenty patients with a single attack of APAC, were retrospectively assessed in this study. Patients were assessed with the Heidelberg retinal tomography (HRT3) and scanning laser polarimeter (GDx-VCC) as well as Humphrey visual field (HVF) repeatedly up to eighteen months after the acute attack. Progression for each imaging modality was assessed with multiple parameters.All patients showed retinal nerve fibre layer (RNFL) and optic disc changes over time. At 18 months, 67% of patients showed progression in 4/5 GDx parameters, and 33% in all 5. HRT analysis similarly showed progression in 4/5 parameters in 70% of patients, and 30% in all 5.This study shows that structural progressive changes to RNFL and ONH occur following APAC confirming that APAC patients need long-term follow-up after the acute attack.