Determinants of post-mydriatic intraocular pressure in phakic eyes with prevalent angle closure diseases
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GLAUCOMA
Determinants of post-mydriatic intraocular pressure in phakic eyes with prevalent angle closure diseases Yu-Chieh Ko 1,2 & Che-Yuan Kuo 1
&
Tung-Mei Kuang 1,2 & Wei-Ta Chen 3 & Pesus Chou 4 & Catherine Jui-ling Liu 1,2
Received: 13 July 2020 / Revised: 14 September 2020 / Accepted: 17 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose This study aimed to identify acute angle closure (AAC) risk following pharmacologic mydriasis and the factors affecting post-mydriatic intraocular pressure (IOP) in a population with a high prevalence of angle closure disease. Methods In total, 460 individuals aged ≥ 72 years were enrolled in this cross-sectional community-based screening program. IOP was measured at baseline and 1 hour after mydriasis. Individuals with post-mydriatic IOP spike > 6 mmHg received indentation gonioscopy and IOP-lowering medication. Linear regression analysis was used to identify ocular parameters associated with post-mydriatic IOP elevation. Results The mean age of participants was 77.8 ± 4.1 years, and 65.4% of them were men. In total, 21 eyes of 16 participants (3.48%) had post-mydriatic IOP spikes (range: 6–13.7 mmHg); among them, 15 eyes had an IOP of > 21 mmHg. None of the participants developed AAC. All eyes with IOP spikes were phakic, except for one with pseudophakic angle closure. Analysis of 381 participants with at least one phakic eye revealed that higher post-mydriatic IOP and IOP changes were associated with narrower angle grading, more extensive peripheral anterior synechiae, shallower central anterior chamber, and thicker lens. According to multiple linear regression analysis, post-mydriatic IOP was independently associated with baseline IOP and factors suggestive of crowded anterior chamber based on gonioscopic findings and central or peripheral anterior chamber depth evaluation in conjunction with lens thickness. Conclusion Post-mydriatic IOP should be measured in phakic eyes with a crowded anterior chamber. Post-mydriatic IOP spikes can be effectively blunted with intervention to prevent AAC. Keywords Acute angle closure . Anterior chamber depth . Gonioscopy . Intraocular pressure . Pharmacologic mydriasis
Introduction Glaucoma is the leading cause of irreversible blindness worldwide [1]. The socioeconomic burden of glaucoma blindness is even greater in East Asia because of the high prevalence of primary angle closure glaucoma (PACG), which is more visually destructive than primary open-angle glaucoma (POAG) * Che-Yuan Kuo [email protected] 1
Department of Ophthalmology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Rd., Taipei 11217, Taiwan
2
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
3
Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
4
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
[2]. Angle closure disease may evolve asymptomatically from primary angle closure suspect (PACS
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