Purpose To evaluate the changes in th e configuration of the drainage angle in the first year afte r acute primary angle closure(APAC).Design Prospective observational case series.Participants Forty-four As ian subjects with APAC.Methods Acute primary angle closure cases were treated with medical therapy followed by laser peripheral iridotomy (LPI ).Static and dynamic gonioscopies we re performed in APAC-affected and fellow eyes before LPI (baseline)and then at 2weeks,4months,and 12month s after presen-tation.The angles were graded in eac h quadrant according to the Shaffer scheme,and the number of clock hours of peripheral anterior synechiae(PAS)was recorded.Pa-tients who underwent intraocular su rgery at any point during follow-up were excluded from the stu dy.Intraocular pressure(IOP)and medical treatment were document ed at each visit,and gonioscopic changes were correlated with the development of elevation in IOP requiring medi-cal treatment.Main outcome measure s Average Shaffer grade and the number of clock hours of PAS.Results The majority of subjects were Chinese(84%)and female(64%),and the mean age was 60.2±10.7years.At presentation,73%of both affected a nd fellow eyes had very narrow angles(average Shaffer grade≤1),with affected eyes having more extensive PAS(P<0.001),a third of whom had≥8clock hours of PAS.In APAC eyes,there was a significant increase in angle width from baseline to 2weeks after LPI (P=0.045),but no change in angle width subsequently.Fellow eyes showed a widening of the angle between baseline and week 2(P=0.01)and from week 2to month 4(P=0.001).There was no significant change in PAS in either affected or fe llow eyes over the 12months of follow-up.Of the 44subjects,19(41.3%)subsequently developed IOP elevati on during follow-up that required treatment.However,there was no difference in angle width or amount of PAS between e yes with and without a subsequent rise in IOP,and the angle configu-ration did not change significantly in either group over 1year.Conclusion In Asian eyes with A PAC,the angle widened in the first 2weeks after LPI ,but did not change there after over 1year,and the amount of PAS remained stable throughout.The results indi cate the effectiveness of LPI in preventing progressive closu re of the angle in the first year after APAC.
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