Longitudinal changes of angle configuration in primary angle-closure suspects: The Zhongshan angle-closure prevention trial

Yuzhen Jiang, Dolly S. Chang, Haogang Zhu, Anthony P. Khawaja, Tin Aung, Shengsong Huang, Qianyun Chen, Beatriz Munoz, Carlota M. Grossi, Mingguang He, David S. Friedman, Paul J. Foster

Research output: Contribution to journalArticlepeer-review


Objective To determine longitudinal changes in angle configuration in the eyes of primary angle-closure suspects (PACS) treated by laser peripheral iridotomy (LPI) and in untreated fellow eyes. Design Longitudinal cohort study. Participants Primary angle-closure suspects aged 50 to 70 years were enrolled in a randomized, controlled clinical trial. Methods Each participant was treated by LPI in 1 randomly selected eye, with the fellow eye serving as a control. Angle width was assessed in a masked fashion using gonioscopy and anterior segment optical coherence tomography (AS-OCT) before and at 2 weeks, 6 months, and 18 months after LPI. Main Outcome Measures Angle width in degrees was calculated from Shaffer grades assessed under static gonioscopy. Angle configuration was also evaluated using angle opening distance (AOD250, AOD500, AOD750), trabecular-iris space area (TISA500, TISA750), and angle recess area (ARA) measured in AS-OCT images. Results No significant difference was found in baseline measures of angle configuration between treated and untreated eyes. At 2 weeks after LPI, the drainage angle on gonioscopy widened from a mean of 13.5° at baseline to a mean of 25.7° in treated eyes, which was also confirmed by significant increases in all AS-OCT angle width measures (P<0.001 for all variables). Between 2 weeks and 18 months after LPI, a significant decrease in angle width was observed over time in treated eyes (P<0.001 for all variables), although the change over the first 5.5 months was not statistically significant for angle width measured under gonioscopy (P = 0.18), AOD250 (P = 0.167) and ARA (P = 0.83). In untreated eyes, angle width consistently decreased across all follow-up visits after LPI, with a more rapid longitudinal decrease compared with treated eyes (P values for all variables ≤0.003). The annual rate of change in angle width was equivalent to 1.2°/year (95% confidence interval [CI], 0.8-1.6) in treated eyes and 1.6°/year (95% CI, 1.3-2.0) in untreated eyes (P<0.001). Conclusions Angle width of treated eyes increased markedly after LPI, remained stable for 6 months, and then decreased significantly by 18 months after LPI. Untreated eyes experienced a more consistent and rapid decrease in angle width over the same time period.

Original languageEnglish (US)
Pages (from-to)1699-1705
Number of pages7
Issue number9
StatePublished - Sep 2014


  • AOD
  • ARA
  • AS-OCT
  • Abbreviations and Acronyms
  • CI
  • IOP
  • IT750
  • LPI
  • PACG
  • PACS
  • TISA
  • ZAP
  • Zhongshan Angle-Closure Prevention
  • angle opening distance
  • angle recess area
  • anterior segment optical coherence tomography
  • confidence interval
  • intraocular pressure
  • iris thickness measured at 750 μm from the scleral spur
  • laser peripheral iridotomy
  • primary angle-closure glaucoma
  • primary angle-closure suspects
  • trabecular-iris space area

ASJC Scopus subject areas

  • Ophthalmology


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