An evaluation of treatment and follow up of angle closure patients – Audit in a single eye unit, National Eye Hospital, Sri Lanka

Objective: To evaluate adherence and efficacy of treatment guidelines used in the management of angle closure patients.
Treatment guideline practised in the eye unit is based on the clinical guidelines – The Management of Angle Closure Glaucoma – The Royal College of Ophthalmologists – 2020 and Guideline for Management of Glaucoma – College of Ophthalmologists of Sri Lanka.
Method: Retrospective hospital-based audit.
Material: 101 clinic registered, patients with angle closure (2010 to July 2022) were analyzed using the data extracted from patients’ clinic records.
Results: 56 (55%) patients presented with acute angle closure attack. Gonioscopy was performed in 93 (92%) patients on presentation. Initial medical management with intravenous manitol needed in 30%, oral acetazolamide in 50% with oral Kcl in 40%, topical anti glaucoma drugs in 93% and topical steroids in 18% patients on presentation. Post treatment intra ocular pressure (IOP) reduction (<21mmHg) noted in 64% of patients. Laser Peripheral Iridotomy (LPI) done in 85 (84%) patients, in which 72%done without any delay. IOP reduction (<21mmHg) noted in 70% of patients. 23 patients eventually needed trabeculectomy with resultant good IOP control. 74 patients needed cataract extraction.
On follow up; 83% continued with topical anti glaucoma drugs, 5% treatment free and 12 patients defaulted follow up. Repeated gonioscopy was performed in 63% of patients. Regular IOP monitoring, Cup to Disc ratio (C: D), Visual Field (VF) assessments were done accordingly. Documented yearly Optical Coherence Tomography (OCT) noted in 60%of patients.
Conclusion: Study demonstrates that the current treatment protocol is adhered in most of the stages which resulted in favourable IOP control and outcome. Though there is a place for improvement in view of measuring post LPI IOP in 1 hour and stopping continuation of unnecessary drug treatment.