Purpose: The aim of this study was to evaluate the choroidal thickness (CT) and its determinants in primary angle closure glaucoma (PACG) eyes with and without malignant glaucoma (MG). Methods: In this cross-sectional study, we enrolled 25 patients with bilateral primary angle closure (PAC) diseases; 1 eye of each patient was diagnosed with PACG initially and later with MG after trabeculectomy, and the fellow eyes were diagnosed with PACG, PAC, or PAC suspect. Thirty-seven eyes from 37 PACG patients were recruited as controls. CT was measured at different locations (sub-fovea, 1 and 3 mm from the fovea) using spectral-domain optical coherence tomography. Comparisons of CT were made among MG, the fellow eyes, and the controls. The associations between the determinants and MG were analyzed by univariate and multiple logistic regression analysis. Results: Macular CT in the eyes with MG was thicker than that of the controls (p < 0.001) but not the fellow eyes. Thicker foveal CT was associated with an increased risk of MG (odds ratio 1.141). Conclusions: Thicker foveal CT is an anatomic risk factor for MG. The results of our study were consistent with the hypothesis that choroidal expansion may play a significant role for the development of MG.

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