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

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).

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.

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.

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.