The damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma.

PURPOSE: To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT).

METHODS

Twenty four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after remission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled less than 21 mm Hg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 month after IOP controlled. Repeated measures ANOVA was used to examine the time course of changes after IOP controlled in RNFL thickness in both acute attack and unaffected fellow eyes of APACG and eyes with CPACG.

RESULTS

The mean RNFL thickness (μm) for the APACG-attacked eyes increased significantly within 3 days (121.49±23.84) after acute strike and then became thinner along with time (107.22±24.72 at 2 week, 93.58±18.37 at 1 month, 84.10±19.89 at 3 month and 78.98±19.17 at 6 month). In APACG-attacked eyes, there were significant differences of average RNFL thickness among 5 different times after IOP was controlled (P ＜ 0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness among 5 different times (F = 0.450, P = 0.104 in APACG unaffected fellow eyes and F = 1.558, P = 0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F = 1.912，P = 0.003).

CONCLUSION

RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.