Corneal endothelium in primary angle closure glaucoma with a history of acute attack in Northeast India

Objectives: Acute angle-closure glaucoma (AACG), a subset of primary angle-closure glaucoma (PACG), is marked by a sudden increase in intraocular pressure (IOP). AACG is considered an ocular emergency due to its rapid onset and distinct anatomical pathology, requiring immediate treatment. Timely diagnosis, prompt intervention, and appropriate referral are crucial for improving patient outcomes and reducing morbidity. Following AACG attacks, a reduction in corneal endothelial cell density has been documented, as elevated IOP can damage the corneal endothelium like mechanical trauma. Corneal endothelium undergoes morphological alteration following an episode of AACG. The study aims to evaluate corneal endothelial cell density using specular microscopy in patients reporting with AACG. Material and Methods: A prospective consecutive observational study was conducted on 16 eyes of patients with PACG that had experienced a symptomatic acute attack in one eye, and compared with their fellow eyes, which were diagnosed as primary angle-closure suspects. Subjects having other intraocular pathology, corneal disease, contact lens user, history of ocular surgery or trauma, or those having congenital abnormalities were excluded. The Goldmann Applanation tonometer was used to measure IOP. Endothelial images were obtained by indirect specular microscopy (TOPCON -3000P) and were then analyzed. Results: The average increase in IOP in eyes experiencing an acute attack of PACG (cases) was 49.69 mmHg, whereas the fellow eyes without a history of such attacks (control) had an average increase in IOP of 16.13 mmHg. The mean endothelial cell count in cases was 1964 cells/mm 2 , while in the control group it was 2359 cells/mm 2 . This represented a 17% depletion in mean endothelial cell density compared to the fellow eye. No significant correlation was observed between the duration of the attack and the decrease in corneal endothelial cell density. Conclusion: A significant reduction in corneal endothelial cell density was observed in eyes following an acute attack of PACG.