SD-OCT assessment and visual field changes 1 year or more after a single episode of unilateral acute primary angle closure

Merola, Rafael Vidal; Cronemberger, Sebastião; Borges, Érica de Abreu; Prates, Jamily Batista

doi:10.37039/1982.8551.20220069

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Revista Brasileira de Oftalmologia

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Original Article • Rev. bras.oftalmol. 81 • 2022 • https://doi.org/10.37039/1982.8551.20220069 copy

SD-OCT assessment and visual field changes 1 year or more after a single episode of unilateral acute primary angle closure

Avaliação do SD-OCT e mudanças do campo visual 1 ano ou mais após episódio único de fechamento angular primário agudo unilateral

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate structural and visual field (VF) changes after ≥1 year of a single acute primary angle closure (APAC) attack using spectral-domain optical coherence tomography (SD-OCT) and standard automated perimetry (SAP).

Methods:

Patients with a single unilateral APAC crisis at least 1 year ago were included consecutively from 2013 to 2016. Contralateral eye was used as control. All patients underwent ophthalmic examination, RNFL imaging by SD-OCT, and SAP using Octopus 1-2-3.

Results:

54 eyes (27 patients) were enrolled. Male-to-female ratio was 1:2. Mean time for the SD-OCT and SAP assessment after the crisis was 5.0±5.1 (1.0–23.5) years, and IOP was 52.5±9.8 mmHg. In APAC eyes, the thicknesses of all quadrants of peripapillary RNFL (36.3%; P<0.001) and some macular sections (from 2.1% to 4.7%; P<0.01) were reduced compared to contralateral eyes. Additionally, in APAC eyes, the mean defect on VF was negatively and statistically correlated with the reduction of all quadrants of peripapillary RNFL thickness.

Conclusion:

A single episode of APAC was associated with peripapillary RNFL and macular thickness and with VF defects after ≥1 year of the crisis in the affected eye. Statistically meaningful correlations were found between structural and functional damage.

Keywords:
Tomography, optical coherence; Visual fields; Glaucoma, angle-closure; Optic disc; Macula lutea

	APAC affected eyes (n=27)	Fellow eyes (n=27)	p-value
Age (years) at presentation	60.5±9.7 (43-79)
Males/females, n(%)	9 (33.3)/18 (66.7)
Leukodermic/pheodermic/melanodermic, n(%)	13 (48.1)/13 (48.1)/1 (3.8)
APAC affected eye, n(%)	8 (29.6) right/ 19 left (70.4)
Family history of glaucoma, n(%)	16 (59.3) positive/ 11 (40.7) negative
Interval between APAC crisis and IOP control (hours), mean±SD	68.9±82.8 (10-360)
Interval between APAC crisis and examination (years), mean±SD	5.0±5.1 (1.0-23.5)
BCVA, mean±SD	0.64±0.29	0.83±0.22	0.003
Baseline IOP (mmHg), mean±SD	52.5±9.8	15.5±4.0	<0.001
Vertical CDR, mean±SD	0.56±0.28	0.30±0.13	<0.001
Keratometry (diopters), mean±SD	44.70±1.68	44.74±1.85	0.822
CCT (μm), mean±SD	537±30.2	540±26.5	0.385
AL (mm), mean±SD	21.81±0.63	21.69±0.71	0.074
Ocular hypotensive medication (number of eyes) n(%)	8 (29.6)	5 (18.5)
Cataract surgery (number of eyes) n(%)	7 (25.9)	7 (25.9)
Trabeculectomy (number of eyes) n(%)	3 (11.1)	1 (3.7)
Combined cataract and glaucoma surgery (number of eyes) n(%)	4 (14.8)	0 (0)
Combined cataract and goniosynechialysis surgery (number of eyes) n(%)	1 (3.7)	0 (0)

	APAC Affected eyes (n=27)	Fellow eyes (n=27)	% reduction affected-fellow eyes	p-value
MD	11.0±9.3	2.9±3.0		<0.001
CLV	20.7±20.0	12.9±15.4		0.052
Peripapillary RNFL thickness
Global	64.5±20.4	101.2±10.9	36.3	<0.001
Temporal superior	82.5±30.1	140.1±25.4	41.1	<0.001
Temporal	56.3±12.5	72.3±12.6	22.1	<0.001
Temporal inferior	80.9±29.5	147.4±24.3	45.1	<0.001
Nasal superior	71.5±30.5	110.3±24.9	35.2	<0.001
Nasal	47.1±17.3	70.0±20.7	32.7	<0.001
Nasal Inferior	75.3±36.0	116.2±38.6	35.2	<0.001
Macular thickness
Center point	235.1±26.4	231.5±22.5		0.176
Fovea	269.9±23.6	263.8±21.3		0.092
Inner superior	322.0±23.4	333.8±17.0	3.5	0.001
Outer superior	285.6±26.9	293.5±15.8		0.147
Inner inferior	315.6±25.7	328.4±16.0	3.9	0.003
Outer inferior	267.5±21.3	273.2±23.8	2.1	0.015
Inner nasal	325.0±20.3	333.6±16.6	2.6	0.011
Outer nasal	295.3±20.9	310.0±17.3	4.4	<0.001
Inner temporal	307.9±22.6	320.4±17.6	3.9	0.002
Outer temporal	270.9±21.3	280.8±15.6	3.5	<0.001

Peripapillary RNFL thickness
	Global	Nasal superior	Nasal	Nasal inferior	Temporal superior	Temporal	Temporal inferior
MD	r=-0.832 (p<0.001)	r=-0.792 (p<0.001)	r=-0.735 (p<0.001)	r=-0.565 (p=0.002)	r=-0.847 (p<0.001)	r=-0.654 (p<0.001)	r=-0.825 (p<0.001)
CLV	r=-0.105 (p=0.720)	r=-0.832 (p<0.001)	r=-0.832 (p<0.001)	r=-0.119 (p=0.686)	r=-0.314 (p=0.275)	r=-0.290 (p=0.315)	r=-0.280 (p=0.332)
BCVA	r=0.568 (p=0.002)	r=0.429 (p=0.025)	r=0.465 (p=0.015)	r=0.577 (p=0.002)	r=0.444 (p=0.020)	r=0.478 (p=0.012)	r=0.506 (p=0.007)

Macular thickness
	Inner superior	Inner inferior	Inner nasal	Outer nasal	Inner temporal
MD	r=-0.514 (p=0.006)	r=-0.507 (p=0.007)	r=-0.435 (p=0.023)	r=-0.419 (p=0.029)	r=-0.452 (p=0.018)
CLV	r=-0.043 (p=0.831)	r=-0.285 (p=0.150)	r=-0.112 (p=0.577)	r=-0.139 (p=0.490)	r=-0.229 (p=0.251)
BCVA	r=0.686 (p<0.001)	r=0.587 (p=0.001)	r=0.593 (p=0.001)	r=0.593 (p=0.001)	r=0.554 (p=0.003)

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[1] Corresponding author: Rafael Vidal Merola, Rua Santo Antônio, 416, apto. 604 – Centro Zip code: 36015-000 – Juiz de Fora, MG, Brazil. E-mail: rafaelmerula@hotmail.com