Risk of acute angle closure and changes in intraocular pressure after pupillary dilation in Asian subjects with narrow angles

Raghavan Lavanya, Mani Baskaran, Rajesh S. Kumar, Hon Tym Wong, Paul T K Chew, Paul J. Foster, David S Friedman, Tin Aung

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate the risk of primary acute angle closure (AAC), changes in intraocular pressure (IOP), and associated risk factors after pupil dilation in Asian subjects with narrow angles (primary angle-closure suspects [PACS]). Design: Prospective clinical study. Participants: A total of 471 subjects aged more than 50 years with narrow angles in Singapore. Methods: This study was part of a prospective trial of PACS. Subjects underwent a detailed ophthalmic evaluation including gonioscopy, biometry, pachymetry, and ultrasound biomicroscopy. All subjects underwent pupil dilation with 1% tropicamide eye drops at the baseline visit, before any laser or medical intervention. Intraocular pressure was measured using Goldmann applanation tonometry by the same observer before and 1 hour after pupil dilation. A dose of oral acetazolamide was given before the patient left the clinic. Main Outcome Measures: Intraocular pressure before and after dilation, and an AAC event. Results: The mean age of the 471 subjects was 63.0±6.9 years (mean ± standard deviation); 75.4% were women, and 92.8% were Chinese. Of the 471 participants, 3 (0.64%; 95% confidence interval [CI], 0.131.85) developed AAC within 6 hours of dilation despite pretreatment with oral acetazolamide. Twenty-two subjects (4.67%; 95% CI, 2.956.99) showed a postdilation increase in IOP of 25 mmHg in either eye. Narrower gonioscopic angle width, that is, having a lower mean gonioscopic modified Shaffer grading (coefficient β -0.51; standard error 0.19; P=0.01), and predilation IOP level (coefficient β -0.17; standard error 0.04; P <0.001) were significant risk factors for IOP increase after dilation in multivariate linear regression analysis. Conclusions: The risk of AAC among Asian subjects with narrow angles was low after pupillary dilation with tropicamide and oral acetazolamide prophylaxis. The presence of narrower angle width by gonioscopy was the only clinical parameter identified for a significant IOP increase after pupil dilation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Original languageEnglish (US)
Pages (from-to)474-480
Number of pages7
JournalOphthalmology
Volume119
Issue number3
DOIs
StatePublished - Mar 2012

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Intraocular Pressure
Dilatation
Pupil
Acetazolamide
Tropicamide
Gonioscopy
Confidence Intervals
Acoustic Microscopy
Biometry
Ophthalmic Solutions
Singapore
Manometry
Disclosure
Linear Models
Lasers
Regression Analysis
Outcome Assessment (Health Care)
Prospective Studies

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Lavanya, R., Baskaran, M., Kumar, R. S., Wong, H. T., Chew, P. T. K., Foster, P. J., ... Aung, T. (2012). Risk of acute angle closure and changes in intraocular pressure after pupillary dilation in Asian subjects with narrow angles. Ophthalmology, 119(3), 474-480. https://doi.org/10.1016/j.ophtha.2011.08.033

Risk of acute angle closure and changes in intraocular pressure after pupillary dilation in Asian subjects with narrow angles. / Lavanya, Raghavan; Baskaran, Mani; Kumar, Rajesh S.; Wong, Hon Tym; Chew, Paul T K; Foster, Paul J.; Friedman, David S; Aung, Tin.

In: Ophthalmology, Vol. 119, No. 3, 03.2012, p. 474-480.

Research output: Contribution to journalArticle

Lavanya, Raghavan ; Baskaran, Mani ; Kumar, Rajesh S. ; Wong, Hon Tym ; Chew, Paul T K ; Foster, Paul J. ; Friedman, David S ; Aung, Tin. / Risk of acute angle closure and changes in intraocular pressure after pupillary dilation in Asian subjects with narrow angles. In: Ophthalmology. 2012 ; Vol. 119, No. 3. pp. 474-480.
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abstract = "Objective: To evaluate the risk of primary acute angle closure (AAC), changes in intraocular pressure (IOP), and associated risk factors after pupil dilation in Asian subjects with narrow angles (primary angle-closure suspects [PACS]). Design: Prospective clinical study. Participants: A total of 471 subjects aged more than 50 years with narrow angles in Singapore. Methods: This study was part of a prospective trial of PACS. Subjects underwent a detailed ophthalmic evaluation including gonioscopy, biometry, pachymetry, and ultrasound biomicroscopy. All subjects underwent pupil dilation with 1{\%} tropicamide eye drops at the baseline visit, before any laser or medical intervention. Intraocular pressure was measured using Goldmann applanation tonometry by the same observer before and 1 hour after pupil dilation. A dose of oral acetazolamide was given before the patient left the clinic. Main Outcome Measures: Intraocular pressure before and after dilation, and an AAC event. Results: The mean age of the 471 subjects was 63.0±6.9 years (mean ± standard deviation); 75.4{\%} were women, and 92.8{\%} were Chinese. Of the 471 participants, 3 (0.64{\%}; 95{\%} confidence interval [CI], 0.131.85) developed AAC within 6 hours of dilation despite pretreatment with oral acetazolamide. Twenty-two subjects (4.67{\%}; 95{\%} CI, 2.956.99) showed a postdilation increase in IOP of 25 mmHg in either eye. Narrower gonioscopic angle width, that is, having a lower mean gonioscopic modified Shaffer grading (coefficient β -0.51; standard error 0.19; P=0.01), and predilation IOP level (coefficient β -0.17; standard error 0.04; P <0.001) were significant risk factors for IOP increase after dilation in multivariate linear regression analysis. Conclusions: The risk of AAC among Asian subjects with narrow angles was low after pupillary dilation with tropicamide and oral acetazolamide prophylaxis. The presence of narrower angle width by gonioscopy was the only clinical parameter identified for a significant IOP increase after pupil dilation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.",
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AU - Baskaran, Mani

AU - Kumar, Rajesh S.

AU - Wong, Hon Tym

AU - Chew, Paul T K

AU - Foster, Paul J.

AU - Friedman, David S

AU - Aung, Tin

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N2 - Objective: To evaluate the risk of primary acute angle closure (AAC), changes in intraocular pressure (IOP), and associated risk factors after pupil dilation in Asian subjects with narrow angles (primary angle-closure suspects [PACS]). Design: Prospective clinical study. Participants: A total of 471 subjects aged more than 50 years with narrow angles in Singapore. Methods: This study was part of a prospective trial of PACS. Subjects underwent a detailed ophthalmic evaluation including gonioscopy, biometry, pachymetry, and ultrasound biomicroscopy. All subjects underwent pupil dilation with 1% tropicamide eye drops at the baseline visit, before any laser or medical intervention. Intraocular pressure was measured using Goldmann applanation tonometry by the same observer before and 1 hour after pupil dilation. A dose of oral acetazolamide was given before the patient left the clinic. Main Outcome Measures: Intraocular pressure before and after dilation, and an AAC event. Results: The mean age of the 471 subjects was 63.0±6.9 years (mean ± standard deviation); 75.4% were women, and 92.8% were Chinese. Of the 471 participants, 3 (0.64%; 95% confidence interval [CI], 0.131.85) developed AAC within 6 hours of dilation despite pretreatment with oral acetazolamide. Twenty-two subjects (4.67%; 95% CI, 2.956.99) showed a postdilation increase in IOP of 25 mmHg in either eye. Narrower gonioscopic angle width, that is, having a lower mean gonioscopic modified Shaffer grading (coefficient β -0.51; standard error 0.19; P=0.01), and predilation IOP level (coefficient β -0.17; standard error 0.04; P <0.001) were significant risk factors for IOP increase after dilation in multivariate linear regression analysis. Conclusions: The risk of AAC among Asian subjects with narrow angles was low after pupillary dilation with tropicamide and oral acetazolamide prophylaxis. The presence of narrower angle width by gonioscopy was the only clinical parameter identified for a significant IOP increase after pupil dilation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

AB - Objective: To evaluate the risk of primary acute angle closure (AAC), changes in intraocular pressure (IOP), and associated risk factors after pupil dilation in Asian subjects with narrow angles (primary angle-closure suspects [PACS]). Design: Prospective clinical study. Participants: A total of 471 subjects aged more than 50 years with narrow angles in Singapore. Methods: This study was part of a prospective trial of PACS. Subjects underwent a detailed ophthalmic evaluation including gonioscopy, biometry, pachymetry, and ultrasound biomicroscopy. All subjects underwent pupil dilation with 1% tropicamide eye drops at the baseline visit, before any laser or medical intervention. Intraocular pressure was measured using Goldmann applanation tonometry by the same observer before and 1 hour after pupil dilation. A dose of oral acetazolamide was given before the patient left the clinic. Main Outcome Measures: Intraocular pressure before and after dilation, and an AAC event. Results: The mean age of the 471 subjects was 63.0±6.9 years (mean ± standard deviation); 75.4% were women, and 92.8% were Chinese. Of the 471 participants, 3 (0.64%; 95% confidence interval [CI], 0.131.85) developed AAC within 6 hours of dilation despite pretreatment with oral acetazolamide. Twenty-two subjects (4.67%; 95% CI, 2.956.99) showed a postdilation increase in IOP of 25 mmHg in either eye. Narrower gonioscopic angle width, that is, having a lower mean gonioscopic modified Shaffer grading (coefficient β -0.51; standard error 0.19; P=0.01), and predilation IOP level (coefficient β -0.17; standard error 0.04; P <0.001) were significant risk factors for IOP increase after dilation in multivariate linear regression analysis. Conclusions: The risk of AAC among Asian subjects with narrow angles was low after pupillary dilation with tropicamide and oral acetazolamide prophylaxis. The presence of narrower angle width by gonioscopy was the only clinical parameter identified for a significant IOP increase after pupil dilation. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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