Abstract
<title>Abstract</title> <p> <bold>Background</bold> Acute symptomatic elevation of intraocular pressure (IOP) represents a vision-threatening ophthalmic emergency associated with significant risk of irreversible visual loss if not promptly treated. Epidemiological data regarding acute glaucoma presentations in the Middle East and North Africa (MENA) region remain limited. This study aimed to evaluate the epidemiological profile, clinical characteristics, longitudinal outcomes, and prognostic factors of patients presenting with acute symptomatic IOP elevation to a tertiary ophthalmic emergency department in Egypt. <bold>Methods</bold> This prospective observational cohort study enrolled 116 consecutive patients (125 eyes) presenting to the Ophthalmology Emergency Department of Kasr Al-Ainy Faculty of Medicine between February 2024 and February 2025 with acute ocular symptoms and confirmed IOP ≥ 30 mmHg. All patients underwent standardized ophthalmological examination including best-corrected visual acuity (BCVA), Goldmann applanation tonometry, slit-lamp biomicroscopy, gonioscopy, and fundus evaluation. Patients were followed prospectively for 6 months. Longitudinal outcomes were analyzed using mixed-effects repeated-measures models. Kaplan–Meier survival analysis and multivariable logistic regression were performed to evaluate treatment failure and predictors of poor visual outcome. <bold>Results</bold> The mean age of patients was 54.19 ± 15.55 years, and 62.1% were male. Secondary glaucomas accounted for 64.0% of cases, while acute primary angle closure represented the most common individual diagnosis (34.4%), followed by neovascular glaucoma (27.2%). Mean presenting IOP was 43.85 ± 8.04 mmHg and significantly decreased to 18.22 ± 3.41 mmHg at 6 months (p < 0.001). Mean BCVA improved from 2.21 ± 0.60 LogMAR at baseline to 0.78 ± 0.40 LogMAR at final follow-up (p < 0.001). Treatment failure occurred in 16.8% of eyes and was highest among neovascular glaucoma cases (35.3%). Multivariable analysis identified neovascular glaucoma (adjusted odds ratio [OR] = 4.18, 95% confidence interval [CI]: 1.58–11.05, p = 0.004), delayed presentation > 3 days (OR = 2.82, 95% CI: 1.12–7.10, p = 0.028), baseline IOP > 50 mmHg (OR = 3.51, 95% CI: 1.38–8.93, p = 0.008), and iris neovascularization (OR = 5.12, 95% CI: 2.01–13.04, p = 0.001) as independent predictors of poor visual outcome. <bold>Conclusions</bold> Acute symptomatic IOP elevation in Egyptian emergency ophthalmology practice is characterized by a high burden of secondary glaucoma, particularly neovascular glaucoma. Although substantial reductions in IOP and improvements in visual acuity can be achieved with prompt treatment, outcomes vary significantly according to glaucoma subtype and baseline disease severity. Early diagnosis and timely intervention remain critical for optimizing visual prognosis in acute glaucoma emergencies. </p>