DOI: 10.1097/ijg.0000000000002728 ISSN: 1057-0829

Comparative Evaluation of Functional Aqueous Humor Outflow in Primary Open Angle Glaucoma versus Primary Angle Closure Glaucoma using Aqueous Angiography

Nitika Beri, Anuja Patil, Akshita Sharma, Aafreen Bari, Namrata Sharma, Robert N. Weinreb, Alex S. Huang, Tanuj Dada
Show PDF Cite

Précis:

Aqueous humor outflow (AHO) is significantly lower in primary angle closure glaucoma (PACG) compared to primary open angle glaucoma (POAG).

Aim:

To quantitatively compare circumferential,perilimbal aqueous humor outflow(AHO) pathways in patients of primary open angle glaucoma(POAG) and primary angle closure glaucoma(PACG) using Aqueous Angiography(AA).

Methods:

Thirty-two eyes of 32 patients were included with 16 patients of POAG and 16 age-matched PACG patients presenting with age-related cataract and planned phacoemulsification surgery.IOP and the number of antiglaucoma medications(AGMs) were noted. All patients underwent AA with 0.1% indocyanine green dye injected into the anterior chamber prior to the capsulorrhexis step, followed by capture of images up to 60 seconds. Images at 60 seconds were exported for image analysis, where mean gray value was assessed to calculate angiographic signal intensity(ASI) along the limbus into eight sectors(45° each),four quadrants(90° each) and overall flow(360°) for POAG & PACG.Statistical tests for relationship of age and severity of disease with overall flow were performed.

Results:

The mean age(years) was 58.8±5.8(POAG) and 59.8±8.6(PACG)[ P =0.704]. The mean preoperative IOP[POAG(16.5±2.48 mmHg) & PACG(18.44±4.03 mmHg)] and median number of AGMs[POAG{3 (1.75–3.25)} & PACG{3 (2.75–4)}] between the two groups were comparable( P >0.05).There was no significant difference in the severity of baseline disease for POAG(MD= −16.79±8.73) and PACG(MD= −16.39±9.57), P =0.904.The overall flow was lower in PACG[123.72(105.18–205.68)] compared to POAG[188.32(163.58–234.40)], P =0.029. In multivariate linear regression analysis, higher overall flow in POAG compared to PACG(β=56.705, P =0.010)was noted.The correlation with age[POAG(r= −0.267, P =0.316); PACG(r= −0.301, P =0.256)] and MD[POAG (r=0.106, P =0.697);PACG (r=0.515, P =0.044)]was documented.

Conclusion:

Both POAG and PACG had segmental AHO. PACG eyes had lower functional AHO compared to POAG in phakic, dilated patients. With increasing disease severity, a decrease in overall flow was noted in PACG.

More from our Archive