Etiologies and clinical characteristics of young patients with angle-closure glaucoma: a 15-year single-center retrospective study

Abstract

Purpose: To investigate the etiologies and the clinical characteristics of angle-closure glaucoma (ACG) patients younger than 40 years old in Chinese.

Methods: Inpatients with diagnosis of ACG and diagnosed age younger than or equal to 40 years old, who were admitted in Eye, Ear, Nose, and Throat Hospital Fudan University from 2002 to 2017, were included in this retrospective non-comparative case series. The underlying causes and clinical features for all the patients were analyzed by comprehensive review of medical charts.

Results: A total of 298 patients (463 eyes) met the criteria, including 153 females (51.3%) and 145 males (48.7%); the mean age was 25.6 ± 13.0 years. Primary angle-closure glaucoma (PACG), uveitis, and anterior segment dysgenesis (ASD) were the top three etiologies in our patients, which accounted for 32.6%, 20.3%, and 15.1% of the total patients respectively. PACG mainly occurs after 30 years of age and ASD is the top reason of ACG in patients younger than 20 years old. Other known etiologies include iridocorneal endothelial syndrome, neovascular glaucoma, nanophthalmos, retinitis pigmentosa, spherophakia, bestrophinopathy, persistent fetal vasculature, iridociliary cysts, congenital retinoschisis, Marfan's syndrome, retinopathy of prematurity, familial exudative vitreoretinopathy, congenital retinal folds, Coat's disease, and neurofibromatosis.

Conclusions: We described the uncommon presentation of ACG in Chinese young patients. Although unusual, most of the etiologies could be identified. Therefore, more careful and comprehensive examinations are needed for early detection and timely treatment for young ACG patients.

Keywords: Angle-closure glaucoma; Chinese; Etiologies; Young patients.

Fig. 1

The etiologies of angle-closure glaucoma and their respective proportions in our patients. PACG, primary angle-closure glaucoma; ASD, anterior segment dysgenesis; ICE, iridocorneal endothelial; NVG, neovascular glaucoma; RP, retinitis pigmentosa; PFV, persistent fetal vasculature; ROP, retinopathy of prematurity; FEVR, familial exudative vitreoretinopathy. The proportions were analyzed based on individuals. Six patients were enrolled in two different groups: they all had PACG in one eye, but uveitis (1 patient), ICE syndrome (1 patient), NVG (1 patient), and nanophthalmos (3 patients) in the fellow eye. They were counted 0.5 in each group respectively for statistical analysis