Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report.

Ocular trauma affects millions of people worldwide and is a leading cause of secondary glaucoma. Angle recession is the main cause of post-traumatic glaucoma after blunt eye trauma, and it is usually unilateral. The aim of this paper is to investigate the possible causes of angle recession with a bilateral presentation. Airbag activation during traffic accidents is a likely cause to be ruled out, along with repeated head or eye trauma, due to contact sports or a history of physical abuse. These aspects can aid in early detection, appropriate management, and improved outcomes for patients with ocular trauma. Finally, we report the case of a 75-year-old Caucasian man who developed a bilateral angle recession after an airbag impact, with advanced glaucoma in the right eye and ocular hypertension in the left eye. To our knowledge, this is the first case in the literature of chronic post-traumatic glaucoma probably caused by an airbag.

Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes.

PURPOSE: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). METHODS: This was a 5-year hospital-based retrospective study of children ≤16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. RESULTS: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1-1.25 lines, P = 0.025] increased risk of poor visual outcome. CONCLUSION: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Glaucoma after open globe injury.

Ocular trauma remains a core root of avoidable blindness worldwide. Corneal scarring, lens injury, glaucoma, vitreous hemorrhage, retinal or choroidal detachment and endophthalmitis are sequel to ocular trauma that can lead to blindness. Very few studies have been published to tackle the risk of developing post-traumatic glaucoma after open globe injuries (OGI), however, there are many articles discussing closed eye injury. This review article aims to cover the incidence, risk factors, causes and treatment of glaucoma after open globe injury.

Assessment of the trabeculectomy with 5 fluoruoracil in the treatment of post-traumatic glaucoma

Background: The post-traumatic glaucoma is a major cause inducing blindness of traumatic eyes. Recent, researches have shown that 5 fluoruoracil (5 FU) combined with surgery, which have a better result in treatment of general glaucoma and post-traumatic glaucoma. Objectives: To describe the clinical characteristics of post - traumatic glaucoma and assess the results of trabeculectomy with intra-operative application of 5 FU. Subject and methods: A descriptive, prospective analysis was taken on 32 patients, who had trabeculectomy with intra-operative application of 5 FU from August 2005 to December 2007 in the Traumatic Department of National Institute of Ophthalmology. Results: Post-traumatic glaucoma was seen mainly in young adults 71.9%; anterior angle recession combined lesions accounted for 25%; cataract 62.5%; fluid in anterior chamber 25%; anterior haemorrhage 37.5%. The intraocular pressure (lOP) was successfully controlled at least up to the following six months in 93.8% and the visual acuity was 0.02 and better in 62.5%. Conclusions: Trabeculectomy with antimetabolite therapy is an effective procedure in reducing IOP in post - traumatic glaucoma.