Different damage patterns of retinal nerve fiber layer and ganglion cell-inner plexiform layer between early glaucoma and non-glaucomatous optic neuropathy.

AIM: To compare the damage pattern of the peripapillary retinal nerve fiber layer (pRNFL) and the macular ganglion cell-inner plexiform layer (mGCIPL) between early glaucomatous and non-glaucomatous optic neuropathy (EGON and NGON). METHODS: It is a cross-sectional study. Thirty-eight healthy controls, 74 EGONs and 70 NGONs with comparable average pRNFL loss were included. The NGON group included 23 eyes of optic neuritis (ON), 13 eyes of hereditary optic neuropathy (HON), 19 eyes of toxic optic neuropathy (TON) and 15 eyes of compressive neuropathy (CON). The sectoral pRNFL and mGCIPL thickness obtained by high definition optical coherence tomography were analyzed. RESULTS: Compared to normal controls, the pRNFL thickness in all quadrants showed a decrease in both EGON and NGON group (P<0.001), but the average pRNFL thickness of EGON group was not different to that of NGON group (P=0.94). The inferior and superior pRNFL was thinner in EGON group compared to NGON group (P<0.001). The temporal pRNFL was thinner in NGON group compared to EGON group (P<0.001). No statistically significant difference was found in nasal pRNFL between EGON and NGON. While the nasal pRNFL was thinner in CON than other three types of NGON (P=0.01), no statistically significant difference was found in other three quadrantal pRNFL among the four types of NGON (P>0.05). The mGCIPL of EGON and NGON group were thinner than control group (P<0.001). In EGON group the severest sites of mGCIPL reduction was located at inferotemporal and inferior sectors. While, compared to EGON group, the average mGCIPL of NGON group were significantly thinner, especially in superonasal and inferonasal sectors (P<0.001). CONCLUSION: The damage pattern of pRNFL and mGCIPL caused by glaucoma is distinct from other NGON such as ON, TON, HON and CON, and this characteristic damage pattern is helpful in differentiating early glaucoma from other NGON.

Age related changes of the central lamina cribrosa thickness, depth and prelaminar tissue in healthy Chinese subjects.

AIM: To investigate the variation in the central lamina cribrosa thickness (cLCT), and the central anterior lamina cribrosa surface depth (cALCSD), as well as the central prelaminar tissue thickness (cPLTT) related to age in healthy Chinese subjects. METHODS: A total of 96 eyes from 96 Chinese healthy subjects were recruited. According to age, the 96 cases were divided into three groups: the young group (YG, 18-39y), middle-age group (MG, 40-59y) and older-age group (OG, 60y and above). Lamina cribrosa images were obtained from all participants using radial linear protocol by enhanced depth imaging spectral-domain optical coherence tomography. The cLCT, cALCSD and cPLTT were calculated from the average value of the lamina cribrosa thickness, anterior lamina cribrosa surface depth and prelaminar tissue thickness in the optic nerve head (ONH) centre point and paracentral points (150 µm from the centre point in the horizontal and vertical directions). RESULTS: For the total subjects, the mean cLCT, cALCSD and cPLTT were 235.18±41.27, 358.02±93.80 and 182.02±92.11 µm, respectively. No statistically significant differences in cLCT, cALCSD or cPLTT were found between gender and different eyes (P=0.27-0.92). The cLCT of the OG was the thickest among the three groups, while the cPLTT of the YG was the thickest among the three groups (P<0.05). Age was positively correlated with cLCT (r=0.42, P<0.001), and negatively correlated with cPLTT (r=-0.24, P=0.02). No significant correlation was found between the age and cALCSD (r=-0.06, P=0.55). And no correlation has been found between axial length and cLCT, cALCSD and cPLTT (P=0.11-0.81). CONCLUSION: The impact of age on the cLCT and the cPLLTT should be taken into account when analysing glaucoma and other diseases related to lamina cribrosa.

Surgical Outcomes of Trabeculotomy in Newborns with Primary Congenital Glaucoma.

BACKGROUND: Early surgical intervention is required for the primary congenital glaucoma (PCG). There are currently few reports on the surgical outcomes in infants with PCG. This study aimed to evaluate the efficacy and safety of trabeculotomy and the postoperative visual outcomes in Chinese newborns with PCG within 4 weeks of birth. METHODS: A total of 21 eyes of 12 patients with PCG who underwent primary trabeculotomy within 4 weeks of birth were retrospectively studied. Preoperative and postoperative intraocular pressure (IOP), corneal clarity and diameter, axial length and optic disc cupping, visual acuity and postoperative refractive error, success rates, and complications were evaluated. Kaplan-Meier survival analysis was applied to evaluate the success rates. RESULTS: The mean follow-up time was 46.9 ± 34.4 months (range: 12-122 months). The postoperative IOP was significantly lower than the preoperative IOP at all of the follow-up visits (P < 0.001). The complete success rates for all eyes at 1, 2, 3, and 5 years postoperatively were 90.5%, 85.7%, 85.7%, and 85.7%, respectively. The IOPs of the three patients who needed antiglaucomatous medications postoperatively were also well controlled. At the last visit, the cornea became clear, and the cup-to-disc ratio decreased significantly (P = 0.01) although the horizontal corneal diameter did not change significantly (P = 0.11). Visual acuities were able to be recorded in eight eyes at the last visit, among which six eyes had a best-corrected visual acuity of 20/40 or better. There were no severe intraoperative or postoperative complications. CONCLUSIONS: Trabeculotomy proves to be a safe and effective treatment in reducing IOP in this group of Chinese newborns with PCG. The outcomes of vision function were satisfactory in most of the patients.

Damage to the Blood-Aqueous Barrier in Ocular Blunt Trauma and Its Association with Intraocular Pressure Elevation.

BACKGROUND: The aim of this study is to provide a quantitative evaluation of the blood-aqueous barrier (BAB) in patients with ocular blunt trauma and evaluate its association with intraocular pressure (IOP) elevation. METHODS: This is a prospective case-control study, and the following 3 groups were included: elevated IOP (45 patients with an elevated IOP secondary to ocular blunt trauma), normal IOP (27 patients with a normal IOP after ocular blunt trauma), and healthy controls. The main outcome measures were IOP and BAB function evaluated using a laser flare-cell meter (LFCM). RESULTS: Patients had significantly higher flare intensities and cell counts than the normal controls (both p < 0.001), and the elevated-IOP group displayed even higher LFCM readings than the normal-IOP group. Aqueous flare and cell readings were positively correlated with IOP (r = 0.529 and 0.590, respectively, p < 0.001). LFCM readings in the elevated-IOP group were still significantly high even on postraumatic day 120 following anti-inflammatory treatment. CONCLUSION: BAB dysfunction occurred following ocular blunt trauma. Eyes with an elevated IOP displayed a more seriously disturbed BAB and a longer recovery course. Examination with a LFCM provides insight into the pathophysiology of IOP elevation and assists in making decisions concerning anti-inflammatory treatment during follow-up.

Therapeutic Effects of Sodium Hyaluronate on Ocular Surface Damage Induced by Benzalkonium Chloride Preserved Anti-glaucoma Medications.

BACKGROUND: Long-term use of benzalkonium chloride (BAC)-preserved drugs is often associated with ocular surface toxicity. Ocular surface symptoms had a substantial impact on the glaucoma patients' quality of life and compliance. This study aimed to investigate the effects of sodium hyaluronate (SH) on ocular surface toxicity induced by BAC-preserved anti-glaucoma medications treatment. METHODS: Fifty-eight patients (101 eyes), who received topical BAC-preserved anti-glaucoma medications treatment and met the severe dry eye criteria, were included in the analysis. All patients were maintained the original topical anti-glaucoma treatment. In the SH-treated group (56 eyes), unpreserved 0.3% SH eye drops were administered with 3 times daily for 90 days. In the control group (55 eyes), phosphate-buffered saline were administered with 3 times daily for 90 days. Ocular Surface Disease Index (OSDI) questionnaire, break-up time (BUT) test, corneal fluorescein staining, corneal and conjunctival rose Bengal staining, Schirmer test, and conjunctiva impression cytology were performed sequentially on days 0 and 91. RESULTS: Compared with the control group, SH-treated group showed decrease in OSDI scores (Kruskal-Wallis test: H = 38.668, P < 0.001), fluorescein and rose Bengal scores (Wilcoxon signed-ranks test: z = -3.843, P < 0.001, and z = -3.508, P < 0.001, respectively), increase in tear film BUT (t-test: t = -10.994, P < 0.001) and aqueous tear production (t-test: t = -10.328, P < 0.001) on day 91. The goblet cell density was increased (t-test: t = -9.981, P < 0.001), and the morphology of the conjunctival epithelium were also improved after SH treatment. CONCLUSIONS: SH significantly improved both symptoms and signs of ocular surface damage in patients with BAC-preserved anti-glaucoma medications treatment. SH could be proposed as a new attempt to reduce ocular surface toxicity, and alleviate symptoms of ocular surface damage in BAC-preserved anti-glaucoma medications treatment.

Anticipation, anti-glaucoma drug treatment response and phenotype of a Chinese family with glaucoma caused by the Pro370Leu myocilin mutation.

AIM: To describe the anticipation and anti-glaucoma drugs response of a Chinese family with juvenile-onset open angle glaucoma (JOAG) caused by the Pro370Leu myocilin (MYOC) mutation. METHODS: Fifteen members of a three-generation Chinese family with JOAG were recruited to this study. They all underwent ophthalmic common examinations. Patients suspected to have JOAG got an assessment of visual field and optical coherence tomography. Intraocular pressures (IOPs) of four patients were measured at 8, 10, 12, 14, 17 o'clock respectively after using anti-glaucoma drugs. Mutation screening of all MYOC gene coding exons of the participants was performed by using direct sequencing of PCR products. RESULTS: Clinical examinations and pedigree analysis revealed eight family members were suffered from JOAG. Apparent genetics anticipation phenomenon was observed in this family. Their clinical features included elevated IOP of 35-55mmHg, loss of visual field, thinning of retinal nerve fiber layer, and glaucomatous optic disc damage. Noticeably, their intraocular pressure levels could be controlled within normal range at 8 and 10 o'clock by anti-glaucoma drugs, but their IOPs would elevate >21mmHg after 12 o'clock. Seven patients received trabeculectomy produced thin-walled, pale, and saccate filtering blebs maintaining lower intraocular pressure efficiently. Mutation screening indentified a heterozygous C→T missense mutation in the MYOC gene at position 1 109 in exon 3, corresponding to a substitution of a highly conserved proline to leucine at codon 370 in the olfactomedin domain of MYOC. CONCLUSION: The clinical characteristics of JOAG in this family were 1) genetics anticipation; 2) high IOP; 3) temporay response to anti-glaucoma drugs; 4) filtering surgery produced thin-walled and saccate filtering blebs, helping maintain lower IOP.

[Detection of the anterior segment configuration of primary angle-closure glaucoma by anterior segment optical coherence tomography].

OBJECTIVE: To quantitatively measure and evaluate the ocular anterior segment parameters in different subtypes of primary angle-closure glaucoma (PACG) using anterior segment optical coherence tomography (AS-OCT). METHODS: This retrospective study collected Fifty-five subjects (55 eyes) with APACG, 63 (63 eyes) with chronic primary angle-closure glaucoma (CPACG) and 90 (90 eyes) normal controls from December 2009 to December 2010 in Zhongshan Ophthalmic Center. AS-OCT examination was performed on all patients and the anterior segment parameters were recorded including: central anterior chamber depth (ACD), anterior chamber width (ACW), anterior chamber volume (ACV), angle opening distance (AOD), trabecular iris area (TISA), angle recess area (ARA), lens thickness (LT) and crystalline lens rise (CLR). The differences of parameters between APACG, CPACG and normal controls were compared. RESULTS: The anterior segment parameters of APACG and CPACG were significantly (P ≤ 0.001) smaller, respectively, than those of normal controls (PACG: ACD 1.81 ± 0.25 mm, ACW 11.30 ± 0.43 mm, AOD 0.039 mm, ARA 0.038 mm(2), ACV 72.8 ± 16.04 mm(3), TISA 0.017 mm(2), Mean ± SD, and CPACG: ACD 2.02 ± 0.25, ACW 11.49 ± 0.45, AOD 0.042, ARA 0.053, ACV 83.60 ± 19.49, TISA 0.022 vs. normal: ACD 2.70 ± 0.35, ACW 11.81 ± 0.47, AOD 0.260, ARA 0.197, ACV 148.52 ± 31.89, TISA 0.100). The LT and CLR of PACG were significantly (P < 0.001) larger, respectively, than that of normal controls (LT: APACG 5.22 ± 0.38, CPACG 5.06 ± 0.36 mm, CLR: APACG 1.07 ± 0.26, CPACG 0.94 ± 0.21 mm vs. normal: LT 4.57 ± 0.42, CLR 0.39 ± 0.33 mm). Compared with CPACG, the anterior segment parameters of APACG were significantly (P < 0.001 - 0.015) decreased, but the LT (P = 0.003) and CLR were significantly (P < 0.001) increased. Compared with APACG-fellow eyes, the anterior segment parameters of APACG-attacked eyes were significantly (P < 0.001 - 0.041) decreased (Fellow-eye: ACD 1.90 ± 0.23 mm, AOD 0.045 mm, TISA 0.037 mm(2), ARA 0.047 mm(2) vs. attached-eye: ACD 1.81 ± 0.25, AOD 0.039, TISA 0.017 and ARA 0.038), while CLR was significantly (t = 1.349, P = 0.043) increased (fellow-eye: 1.01 ± 0.23 mm vs. Attached-eye: 1.07 ± 0.26). There was no significant difference in the other AS-OCT parameters between APACG-attacked eyes and fellow eyes (t = 0.574 - 1.147, P = 0.257 - 0.567). CONCLUSIONS: Our results indicated a more crowding anterior segment configuration in PACG than that in normal controls and a more anterior located and thicker lensing APACG than that in CPACG, which constitute a morphological basis of acute attack.

[Fundus features of nanophthalmos analyzed by optical coherence tomography].

OBJECTIVE: To observe the fundus features of nanophthalmos with or without secondary glaucoma using spectral domain optical coherence tomography (SD-OCT). METHODS: It was a retrospective case-series study. Twenty-three eyes of 12 patients (6 female, 6 male) who were clinically identified to be nanophthalmos (axial length ≤ 20.0 mm) in Zhongshan Ophthalmic Center from June 2008 to December 2010 and twenty-three eyes of 23 age and sex matched normal controls were included in this study. All patients underwent ophthalmological examinations including best-corrected visual acuity, refraction, slit-lamp biomicroscopy and fundus examination, Goldmann applanation tonometry, A-scan and B-scan ultrasound examinations, ultrasound biomicroscopy, fundus photography and spectral domain optical coherence tomography (SD-OCT). All examinations were carried out with natural pupil. The fundus features detected by OCT were compared between nanophthalmos and normal controls, and among nanophthalmos with or without secondary glaucoma.Independent-samples t test was used to analyze the difference of retinal thickness between nanophthalmoic eyes and controls and also between nanophthalmoic eyes with and without secondary glaucoma. Pearson correlation analysis was used to analyze the correlation between axial length and macular retinal thickness. RESULTS: The average age of 12 patients was (25.0 ± 13.1) years, and the mean axial length was (17.30 ± 1.66) mm. Thirteen eyes suffered from secondary glaucoma because of angle closure with average intraocular pressure (IOP) of (28.62 ± 9.18) mm Hg (1 mm Hg = 0.133 kPa). The average IOP of the other 10 eyes without secondary glaucoma was (14.96 ± 3.21) mm Hg.OCT images revealed thickening of the retina in macular fovea, with residual retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, and broadened outer nuclear layer in 23 eyes with nanophthalmos. Pre-retinal folds were seen in 5 eyes with macular cysts.Shallow serous retinal detachment was found in 3 eyes, 2 of which showed focal thickening of retinal pigment epithelium as leopard spots. The cup were not obvious and retina around optic nerve head was thickened in 10 eyes without secondary glaucoma and 4 eyes with secondary early glaucoma, which seemed to be pseudopapilloedema. The other 9 eyes with secondary late glaucoma revealed enlarged cup . The mean macular foveal thickness of nanophthalmic eyes[ (335.65 ± 91.45) µm] was significantly thickened than normal control group [(192.72 ± 11.18) µm] (t = 10.50, P = 0.000) . The mean macular foveal thickness of nanophthalmos with glaucoma [(323.70 ± 104.09) µm] was thinner than those without glaucoma [(403.50 ± 130.24) µm] (t = 3.50, P = 0.002). Macular foveal thickness were negatively related with axial length in both nanophthalmos with and without secondary glaucoma (R = -0.797, P = 0.001). CONCLUSIONS: Macular hypoplasia and crowded optic nerve head are two important characteristic of fundus appearances in nanophthamos.SD-OCT can clearly reveal the changes of macular retina and optic nerve head. SD-OCT will be a very useful tool to help diagnose nanophthamos and evaluate its possible complications.

[Protection effect of sodium hyaluronate on ocular surface toxicity induced by Benzalkonium chloride-preserved brimonidine in rabbits].

OBJECTIVE: To investigate the protective effects of sodium hyaluronate on ocular surface toxicity induced by a prolonged use of benzalkonium chloride-preserved Brimonidine eye drops. METHODS: Experimental study. Thirty adult female New Zealand rabbits were divided into three groups with randomized numbers design. Ten rabbits were treated with 0.2% Brimonidine eye drops and PBS (PBS group), the other ten rabbits with 0.2% Brimonidine combined with sodium hyaluronate eye drops (SH group), and control group received no treatment for 60 days. Schirmer test, fluorescein (FL) and Rose Bengal (RB) staining, conjunctival impression cytology specimens collecting were performed on day 0, 31, and 61. Apoptosis of conjunctival epithelium was detected by in situ terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay on day 61. Conjunctival inflammation was observed by hematoxylin eosin staining. Histomorphological changes of cornea and conjunctiva were observed by light microscopy, and scanning and transmission electron microscopy at day 61. Fluorescein and Rose Bengal scores were analysed by Kruskal-Wallis test. Schirmer scores, goblet cell density and inflammatory cells infiltration were analysed by repeated measures analysis of variance. RESULTS: There were significant differences in fluorescein and Rose bengal (H = 22.031, 15.303, P < 0.01) staining among the groups on day 61. Compared with the control group (FL: 0, 0-1, RB: 0, 0-1), fluorescein and Rose Bengal scores were significantly (P < 0.001) increased in PBS group (FL: 1.5, 1-2, RB: 1, 1-2), whereas was significantly (P < 0.001) decreased in SH group (FL:0, 0-1 RB:1, 0-1) when compared to PBS group. There were significant differences in aqueous tear production and goblet cell density (F = 7.980, 14.545, both P < 0.01) among the groups on day 61. Compared with the control group [(9.43 ± 0.57) mm, (87.73 ± 2.34/HP)], Schirmer scores and goblet cell density were significantly (P < 0.01) reduced in PBS-treated group [(6.61 ± 0.38) mm, (68.06 ± 3.61)/HP], but significantly (P < 0.05) increased in SH-treated group [(8.75 ± 0.57) mm, (82.31 ± 1.64)/HP] compared with PBS-treated group. The number of inflammatory cells was significant difference (F = 56.306, P < 0.001) among the groups on day 61. Compared with the control group [(39.89 ± 2.03)/HP], inflammatory cells infiltration was significantly (P < 0.01) increased in both PBS [(73.18 ± 2.17)/HP] and SH groups [(48.79 ± 2.64)/HP], however, SH-treated group was significantly lowered when compared with PBS-treated group. In addition, decrease in apoptosis, complete microvilli and cell organelles were found in the corneal and conjunctival epithelial cells in SH-treated group. CONCLUSIONS: Our results demonstrate that topical application of SH reduces the ocular toxicity and protect the ocular surface in the long term anti-glaucomatous medical therapies and may be considered as a vehicles or neutralizing material for future ocular application.

[The efficacy of Ahmed glaucoma valve implantation in the management of early stage of glaucoma secondary to blunt ocular trauma].

OBJECTIVE: To evaluate the efficacy and safety of Ahmed glaucoma valve (AGV) implantation in the early stage of glaucoma secondary to contusion injuries. METHODS: A retrospective case series study. The study was made in 29 consecutive patients with glaucoma secondary to blunt trauma who were uncontrolled by multiple medications and then performed AGV implantations in less than 2 months after the trauma. The duration from injury to IOP elevation was 1 to 30 (6.10 ± 1.13) days. The time from injury to AGV implantation was 16 to 60 (40.03 ± 2.97) days. The patients were followed-up for a period of 6 to 42 (20.75 ± 1.66) months. The main outcome measures included intraocular pressure (IOP), visual acuity (VA), number of glaucomatous medications, intra- and postoperative complications. IOPs were analyzed by repeated measures analysis of variance, numbers of medication assessed by Kruskal-Wallis rank sum test followed by Bonferroni test, and VA comparison was performed using paired Student t-test. RESULTS: The absolute success rate was 86.21% and the conditional success rate was 13.79% after AGV implantation. Compared with pre-operation, the IOP was significantly(F = 124.09, P < 0.05) lowered at the last following-up of post-operation(42.59 ± 1.82)vs (15.12 ± 0.56) mm Hg(1 mm Hg = 0.133 kPa), the numbers of glaucomatous medications were significantly (H = 131.73, P < 0.05) reduced post-operatively (3.93 ± 0.15) vs (0.21 ± 0.12) species, and the VA was significantly (t = -3.466, P < 0.05) improved post-operatively (logMAR 0.40 vs logMAR 0.70). Two cases with shallow anterior chamber and three cases with hyphema were observed in the early stage after the surgery. No persistent hypotony, tube exposure or other serious complications were noted. CONCLUSION: AGV implantation is safe and effective in the management of intractable secondary glaucoma at early stage of contusion injuries.

[Comparison of anterior segment changes before and after laser peripheral iridectomy by anterior segment optical coherence tomography in eyes with primary acute angle closure glaucoma].

OBJECTIVE: To evaluate the changes of anterior segment configuration after surgical peripheral iridectomy (SPI) in patients with primary acute angle closure glaucoma (PAACG) by using anterior segment optical coherence tomography (AS-OCT). METHODS: This retrospective self control study consisted of thirty-seven eyes of 37 patients with PAACG who were consecutively recruited in Zhongshan Ophthalmic Center. The peripheral anterior synechiae (PAS) of these patients was less than 5 clock time point. Central anterior chamber depth (ACD), angle opening distance (AOD), trabecular iris area (TISA), angle recess area (ARA), anterior chamber width (ACW), anterior chamber volume (ACV), and crystalline lens rise (CLR) were measured using AS-OCT before and one month after SPI. RESULTS: After SPI, AOD (0.125 ± 0.072) µm, TISA (0.091 ± 0.041) mm(2), ARA (0.095 ± 0.042) mm(2), ACA (14.230 ± 2.000) mm(2) and ACV (90.074 ± 16.796) mm(3) were significantly increased compared with before SPI AOD (0.088 ± 0.078) µm, TISA (0.050 ± 0.048) mm(2), ARA (0.059 ± 0.057) mm(2), ACA (12.332 ± 2.457) mm(2), ACV (73.131 ± 16.976) mm(3) (t = -8.015 to 1.066, P = 0.001 to 0.044), respectively. There were no significantly changes in ACD, ACW and CLR (t = -1.505 to 0.516, P = 0.102 to 0.609). CONCLUSIONS: PAACG can be controlled by SPI resulting in an increase of AOD, TISA, ARA, ACA and ACV, but not ACD or CLR.

Damage patterns of retinal nerve fiber layer in acute and chronic intraocular pressure elevation in primary angle closure glaucoma.

AIM: To observe the differences of damage patterns of retinal nerve fiber layer (RNFL) between acute and chronic intraocular pressure (IOP) elevation in primary angle closure glaucoma (PACG) using optical coherence tomography (OCT). METHODS: Twenty-four patients (48 eyes) with unilateral acute PACG (APACG) attack in the 6 months after admission and 36 patients (64 eyes) with chronic PACG (CPACG) were included in this prospective study. For all cases, IOP has been controlled under 21mmHg after treatment. Using stratus OCT, the RNFL thickness was assessed in eyes with PACG within 3 days, 2 weeks, 1, 3 and 6 months after IOP was controlled. Repeated measures ANOVA was used to examine the changes of RNFL thickness at different time after IOP being controlled in both acute attack eyes and unaffected fellow eyes of APACG and eyes with CPACG. RESULTS: The mean RNFL thickness for the APACG-attacked eyes increased significantly within 3 days (121.49±23.84)µm after acute onset and then became thinner along with time [(107.22±24.72)µm at 2 weeks,(93.58±18.37)µm at 1 month, (84.10±19.89)µm at 3 months and (78.98±19.17)µm at 6 months]. In APACG-attacked eyes, there were significant differences of average RNFL thickness at 5 different times after IOP was controlled (P<0.001). In the APACG unaffected fellow eyes and CPACG eyes, there were no significant differences in mean RNFL thickness at 5 different times(F=0.450, P=0.104 in APACG unaffected fellow eyes and F=1.558, P=0.200 in CPACG eyes). There was significant difference for interaction between time periods and groups (F=1.912, P=0.003). CONCLUSION: RNFL damage patterns are different under different IOP elevated courses. In APACG, RNFL was found to be swollen and thickening right after acute attack and then becomes thinning and atrophy along with the time, while RNFL was found to be diffused thinness in CPACG.