45(3):279-282,2004 OPHTHALMOLOGY Incidence of Acute Angle-Closure Glaucoma in Dalmatia, Southern Croatia Lovro Bojiæ, Zdravko Mandiæ 1 , Milan Ivaniševiæ, Kajo Buèan, Suzana Kovaèeviæ 2 , Antonela Gveroviæ 3 , Alenka Miletiæ-Juriæ 4 Department of Ophthalmology, Split University Hospital Center, Split; 1 Department of Ophthalmology, Sisters of Mercy University Hospital, Zagreb; 2 Department of Ophthalmology, Zadar General Hospital, Zadar; 3 Department of Ophthalmology, Dubrovnik General Hospital, Dubrovnik; and 4 Department of Ophthalmology, Šibenik General Hospital, Šibenik, Croatia Aim. To investigate the incidence of acute angle-closure glaucoma among residents of Dalmatia, southern part of Croatia. Methods. We reviewed hospital records of 176 patients with acute angle-closure glaucoma treated between January 1995 and December 2001 at the Departments of Ophthalmology at four hospitals in Dalmatia. There were 122 women, aged between 29 and 89 years (median age; 68 years), and 54 men, aged between 33 and 88 years (median age, 70 years). Results. The unadjusted crude incidence was 2.9/100,000 (95% confidence interval [CI], 1.6-4.5). The unadjusted crude incidence among men and women was 1.9 (95% CI, 0.3-3.8) and 3.9 (95% CI, 1.7-6.1) cases/100,000 per year, respectively. The relative risk (RR) of developing acute angle-closure glaucoma was 2.1 (95% CI, 1.5-2.9) times higher for women as compared to men. The RR of acute angle-closure glaucoma was 1.9 (95% CI, 0.6-6.2) in the 40-49 years group, 6.5 (95% CI, 2.3-18.8) in the 50-59 years group, 17 (95% CI, 6.3-47.8) in the 60-69 years group, and 28 (95% CI, 10.4-77.3) in the over 69 years group. The median time from the onset of symptoms to presentation at the hospital was 2 days (range, 1-15 days). In 87 (48%) patients intraocular pressure control was achieved by medical treatment, 41 (23%) patients underwent peripheral iridectomy, and 48 (27%) patients required a trabeculectomy. In 35 (73%) out of 48 patients managed by filtering surgery, the delay in treatment was 3 or more days. In 34 (19%) eyes with final visual acuity 0.1 or worse, the delay in presentation was 3 days or more. No statistically significant association was found be- tween acute angle-closure glaucoma and seasonal variation (chi-square=0.85; p=0.8). Conclusion. Earlier recognition of the patients with acute angle-closure glaucoma and a shorter time of delay in presen- tation could have saved many patients from surgery and vision loss each decade. Key words: Croatia; glaucoma, angle-closure; incidence; seasons; therapy Angle-closure glaucoma is a form of glaucoma where the anterior chamber tends to be smaller than average (1). There is a relative block to the passage of aqueous from the posterior to the anterior chamber, because of the contact of the iris with the lens around the pupil. This area is greater if the eye is shorter, as it is in women compared with men, and in hyperopia; or the lens larger, as it is in the older population due to gradual growth of lens; or if the pupil is mid-dilated, as it is when the light is dim (1). A relative pupillary block leads to the accumulation of aqueous in the posterior chamber, which then pushes the root of the iris forward, secondarily closing the chamber angle. When the angle is completely blocked, an acute glau- coma attack occurs (1). Acute angle-closure glaucoma with pupillary block is the condition of rapid rise of intraocular pres- sure due to obstruction of the drainage angle of the anterior chamber, with severe pain and loss of vision (1,2). Acute angle-closure glaucoma is commonly re- garded as an ophthalmologic emergency. Screening programs based on epidemiologic research are need- ed to minimize the blinding impact of acute angle- closure glaucoma (3). Although the epidemiology of acute angle-clo- sure glaucoma has been investigated (4,5), its real in- cidence has not been fully determined (6,7). The highest incidence was recorded among Eskimos in Greenland and Canada (8,9), and the lowest was found among African-Americans (10). Existing popu- lation-based data on acute angle-closure glaucoma have been limited to prevalence surveys among dif- ferent populations, which are not strictly comparable (5,11). Furthermore, the acute, symptomatic phase of www.cmj.hr 279