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Iannucci V, Manni P, Alisi L, Mecarelli G, Lambiase A, Bruscolini A. Bilateral Angle Recession and Chronic Post-Traumatic Glaucoma: A Review of the Literature and a Case Report. Life (Basel) 2023; 13:1814. [PMID: 37763218 PMCID: PMC10532958 DOI: 10.3390/life13091814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023] Open
Abstract
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.
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Affiliation(s)
| | | | | | | | - Alessandro Lambiase
- Department of Sense Organs, Sapienza University of Rome, 00185 Rome, Italy; (V.I.); (P.M.); (L.A.); (G.M.)
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Hou X, Guo X, Cui Z, Wang Y, Zhou J, Hu D. Value of ocular trauma score in predicting the incidence of secondary glaucoma after closed globe injury. Eur J Ophthalmol 2021; 32:3005-3011. [PMID: 34841932 DOI: 10.1177/11206721211055628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To analyze the visual acuity (VA) and the incidence of secondary glaucoma among patients with closed globe injury (CGI). To determine the correlations between the ocular trauma score (OTS) with surgery rate, and evaluate the applicability of OTS in secondary glaucoma prediction and treatment. METHODS We conducted a retrospective review of 265 patients (265 eyes) with CGI admitted to Xijing Hospital between January 2014 and December 2016. The clinical characteristics; VA, IOP, injury zone, surgery, and IOP-lowering medications were collected at the initial visit and at six months. The patients with secondary glaucoma were scored and assessed by the OTS system. The correlation of the anti-glaucoma surgery with the OTS was evaluated. The difference in the number of IOP-lowering medications between the initial visit and six months was analyzed. RESULTS The average age of the patients was 33.5 ± 20.7 years with 80.8% being males. The final VA outcome improved in its totality after treatment. 35 patients developed glaucoma, with an incident rate of 13.2% over six months. All glaucoma patients had an injury in zone I and II, and 12 of them had an injury in zone III. The severity of the OTS category showed a strong correlation with the anti-glaucoma surgery rate. After the surgical intervention, the number of IOP-lowering medications in OTS category 2, 3, and 4 significantly reduced. CONCLUSIONS The OTS has predictive value in the incidence of secondary glaucoma after CGI. A patient with a low score is more likely to develop secondary glaucoma and might require surgical intervention.
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Affiliation(s)
- Xu Hou
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Xinxing Guo
- Wilmer Eye Institute, 23263Johns Hopkins University, Baltimore, MD, USA
| | - Zhili Cui
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Yusheng Wang
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Jian Zhou
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
| | - Dan Hu
- Eye Institute of Chinese PLA and Department of Ophthalmology, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi, China
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Evaluation of primary Ahmed Glaucoma valve implantation in post-traumatic angle recession glaucoma in Indian eyes. Int Ophthalmol 2021; 42:817-827. [PMID: 34648109 DOI: 10.1007/s10792-021-02047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To highlight the efficacy of primary Ahmed glaucoma valve implantation in angle recession glaucoma following blunt ocular trauma in Indian eyes. DESIGN A retrospective analytical study. MATERIALS AND METHODS This study included 52 patients of angle recession glaucoma, who presented between Mar 2006 to Feb 2016, out of which 38 patients had undergone primary AGV implantation, while the rest were managed with topical anti-glaucoma medications. Preoperative data included age, sex, type and mode of injury, duration of injury, assessment of best-corrected visual acuity (BCVA) and intraocular pressure (IOP). The extent of angle recession was observed by gonioscopy. The intraocular pressure, visual acuity, and the number of anti-glaucoma medications were measured postoperatively. The success of this technique was analyzed by using a Kaplan-Meier cumulative survival curve. RESULTS Following AGV implantation, the mean IOP was significantly reduced to 8.7 ± 2.2 at 1st day, 10.1 ± 2.2 at 7th day, 14.2 ± 3.4 at 3rd month, 15.6 ± 3.7 at 1 year, and 15.6 ± 3.6 at 3rd-year follow-up showing statistically significant values (p < 0.001) at each visit. The IOP was successfully controlled at the last follow-up without topical treatment. Mean BCVA at 3 years -post-AGV was 0.144 (0.151) (LogMAR) which was statistically significant (p < 0.001) as compared to the mean BCVA of 0.898 (± 0.205) LogMAR units at presentation. The success rate by Kaplan-Meier survival curve analysis was 90% at the mean follow-up duration of 29.47 ± 3.39 months. Overall surgical complications were noted in the form of prolonged hypotony, hyphema in 7 patients (13.5%). CONCLUSIONS In medically uncontrolled post-traumatic angle recession glaucoma, primary AGV Implantation is a safe and effective surgical procedure with lesser complication rates providing long-term IOP control in a younger population.
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Phu J, Agar A, Wang H, Masselos K, Kalloniatis M. Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach. Clin Exp Optom 2021; 104:367-384. [DOI: 10.1111/cxo.13114] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jack Phu
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
| | - Henrietta Wang
- Centre for Eye Health, The University of New South Wales, Sydney, Australia
| | - Katherine Masselos
- School of Optometry and Vision Science, The University of New South Wales, Sydney, Australia
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Anterior Chamber Angle Evaluation Using Gonioscopy: Consistency and Agreement between Optometrists and Ophthalmologists. Optom Vis Sci 2020; 96:751-760. [PMID: 31592958 DOI: 10.1097/opx.0000000000001432] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
SIGNIFICANCE In our intermediate-tier glaucoma care clinic, we demonstrate fair to moderate agreement in gonioscopy examination between optometrists and ophthalmologists, but excellent agreement when considering open versus closed angles. We highlight the need for increased consistency in the evaluation and recording of angle status using gonioscopy. PURPOSE The consistency of gonioscopy results obtained by different clinicians is not known but is important in moving toward practice modalities such as telemedicine and collaborative care clinics. The purpose of this study was to evaluate the description and concordance of gonioscopy results among different practitioners. METHODS The medical records of 101 patients seen within a collaborative care glaucoma clinic who had undergone gonioscopic assessment by two clinicians (one optometrist and either one general ophthalmologist [n = 50] or one glaucoma specialist [n = 51]) were reviewed. The gonioscopy records were evaluated for their descriptions of deepest structure seen, trabecular pigmentation, iris configuration, and other features. These were compared between clinicians (optometrist vs. ophthalmologist) and against the final diagnosis. RESULTS Overall, 51.9 and 59.8% of angles were graded identically in terms of deepest visible structure when comparing between optometrist versus general ophthalmologist and optometrist versus glaucoma specialist, respectively. The concordance increased when considering ±1 of the grade (67.4 and 78.5%, respectively), and agreement with the final diagnosis was high (>90%). Variations in angle grading other than naming structures were observed (2.0, 30, and 3.9% for optometrist, general ophthalmologist, and glaucoma specialist, respectively). Most of the time, trabecular pigmentation or iris configuration was not described. CONCLUSIONS Fair to moderate concordance in gonioscopy was achieved between optometrists and ophthalmologists in a collaborative care clinic in which there is consistent feedback and clinical review. To move toward unified medical records and a telemedicine model, improved consistency of record keeping and angle description is required.
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Pathophysiology and management of glaucoma and ocular hypertension related to trauma. Surv Ophthalmol 2020; 65:530-547. [PMID: 32057763 DOI: 10.1016/j.survophthal.2020.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
Abstract
Ocular trauma is a significant cause of blindness worldwide, particularly if associated with glaucoma. Direct damage from blunt or penetrating trauma, bleeding, inflammation, lens-related problems, orbital and brain vascular pathologies related to trauma, and chemical injuries may increase intraocular pressure and lead to traumatic glaucoma. Treatment may be as simple as eliminating the underlying cause in some conditions or management can be challenging, depending on the mechanism of damage. If proper management is not undertaken, visual outcomes can be poor. We discuss a broad spectrum of trauma-related mechanisms of intraocular pressure elevation, as well as their management.
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Martini E, Guiducci M, Campi L, Cavallini GM. Ocular Blood Flow Evaluation in Injured and Healthy Fellow Eyes. Eur J Ophthalmol 2018; 15:48-55. [PMID: 15751239 DOI: 10.1177/112067210501500108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE To assess if injured eyes develop ocular blood flow disturbances that may contribute to development of traumatic glaucoma. METHODS Twenty-five eyes of 25 patients hospitalized from January 1997 to July 1999 for blunt (15) or penetrating (10) eye injury and elevated intraocular pressure (IOP) (>23 mm Hg) were controlled at least 24 months after the trauma and underwent visual field examination, pulsatile ocular blood flow (pOBF), and color Doppler imaging (CDI) analysis of ophthalmic artery, central retinal artery, nasal and temporal short posterior ciliary arteries. Uninjured healthy eye was used as control. RESULTS IOP was significantly higher in injured eyes (15.1+/-3.3 vs 13.0+/-2.7 mmHg; p<0.01), but only 2 eyes (8%) were under medical treatment. pOBF values were significantly lower in injured eyes: 11.25+/-6.56 microL/sec in the trauma eyes and 15.40+/-7.29 in fellow eyes (p=0.002). Resistivity index of all investigated retrobulbar vessels was very significantly higher in injured eyes than in fellow eyes (p<0.0001). There is no significant correlation between IOP and ocular blood flow disturbance. CONCLUSIONS Long-term follow-up (mean 39+/-12 months) of injured eyes shows, besides a slight but significant increase of IOP, a very significant impairment of ocular blood supply to injured eyes compared to healthy fellow eyes with reduction of pulsatile ocular blood flow and marked increase of resistance to flow in all retrobulbar vessels. These anomalies may be considered an independent risk factor to develop traumatic glaucoma.
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Affiliation(s)
- E Martini
- Department of Neurosciences, Head-Neck and Rehabilitation, University of Modena and Reggio Emila, Modena - Italy
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Abstract
BACKGROUND An ocular injury can lead to secondary glaucoma in the traumatized eye in 3% to 20% of cases. Literature on the risk of developing elevated intraocular pressure in the nontraumatized fellow eye is scant. Clinicians treating ocular traumas should also bear in mind sympathetic ophthalmia, a rare bilateral granulomatous panuveitis following accidental or surgical trauma to 1 eye. CASE REPORT We report a case of high-pressure glaucoma of the fellow eye without any signs of uveitis. The left eye of a 24-year-old man was injured in an inadvertent movement during a free-time table-tennis match. The eye was severely crushed, leading to blindness. His right eye developed medically uncontrolled high-pressure glaucoma only 1 month after the injury. CONCLUSION To the best of our knowledge, there are no previous reports of post-traumatic glaucoma in the nontraumatized eye after open-globe injury.
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Affiliation(s)
- Anu Vaajanen
- Tays Eye Centre, Tampere University Hospital
- Department of Ophthalmology, School of Medicine, University of Tampere, Tampere, Finland
- Correspondence: Anu Vaajanen, Tampere, Finland (e-mail: )
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Muñoz CR, Macias JH, Hartleben C. Reproducibility of the water drinking test. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2015; 90:517-521. [PMID: 26008923 DOI: 10.1016/j.oftal.2015.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 10/15/2014] [Accepted: 03/23/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To investigate the reproducibility of the water drinking test in determining intraocular pressure peaks and fluctuation. It has been suggested that there is limited agreement between the water drinking test and diurnal tension curve. This may be because it has only been compared with a 10-hour modified diurnal tension curve, missing 70% of IOP peaks that occurred during night. METHODS This was a prospective, analytical and comparative study that assesses the correlation, agreement, sensitivity and specificity of the water drinking test. RESULTS The correlation between the water drinking test and diurnal tension curve was significant and strong (r=0.93, Confidence interval 95% between 0.79 and 0.96, p<01). A moderate agreement was observed between these measurements (pc=0.93, Confidence interval 95% between 0.87 and 0.95, p<.01). The agreement was within±2mmHg in 89% of the tests. DISCUSSION Our study found a moderate agreement between the water drinking test and diurnal tension curve, in contrast with the poor agreement found in other studies, possibly due to the absence of nocturnal IOP peaks. CONCLUSIONS These findings suggest that the water drinking test could be used to determine IOP peaks, as well as for determining baseline IOP.
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Affiliation(s)
- C R Muñoz
- Servicio de Glaucoma, Instituto de Oftalmología Conde de Valenciana F.A.P., Distrito Federal, México.
| | - J H Macias
- Servicio de Glaucoma, Instituto de Oftalmología Conde de Valenciana F.A.P., Distrito Federal, México
| | - C Hartleben
- Servicio de Glaucoma, Instituto de Oftalmología Conde de Valenciana F.A.P., Distrito Federal, México
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Ng DSC, Ching RHY, Chan CWN. Angle-recession glaucoma: long-term clinical outcomes over a 10-year period in traumatic microhyphema. Int Ophthalmol 2014; 35:107-13. [DOI: 10.1007/s10792-014-0027-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/01/2014] [Indexed: 11/30/2022]
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Rogers G, Mustak H, Hann M, Steven D, Cook C. Sutured posterior chamber intraocular lenses for traumatic cataract in Africa. J Cataract Refract Surg 2014; 40:1097-101. [PMID: 24874771 DOI: 10.1016/j.jcrs.2014.01.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/26/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine the outcomes of sutured scleral fixation of posterior chamber intraocular lenses (PC IOLs) after trauma in an African population. SETTING State hospital and affiliated district hospital, Cape Town, South Africa. DESIGN Case series. METHODS A retrospective review was performed of the medical records of patients in whom a sutured PC IOL had been implanted for traumatic aphakia in the preceding 5 years. RESULTS Eighty-five percent of the 59 patients had a significant improvement in uncorrected distance visual acuity (UDVA) at the final visit. Two-thirds of patients achieved an UDVA of 6/18 or better. Those not improving had severe preexisting macular or corneal pathology. A significant number of patients (28%) with angle recession developed ocular hypertension during the postoperative period. CONCLUSION After careful preoperative selection, sutured PC IOLs were effective in the visual rehabilitation of eyes with traumatic subluxated cataract in which the capsular bag could not be retained. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Graeme Rogers
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa.
| | - Hamzah Mustak
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - Mignon Hann
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - David Steven
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
| | - Colin Cook
- From the Division of Ophthalmology (Rogers, Mustak, Cook), Groote Schuur and Red Cross War Memorial Children's Hospitals, and Eerste Rivier Hospital Ophthalmology (Hann, Steven), Eerste Rivier, Cape Town, South Africa
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Bai HQ, Yao L, Wang DB, Jin R, Wang YX. Causes and treatments of traumatic secondary glaucoma. Eur J Ophthalmol 2009; 19:201-6. [PMID: 19253235 DOI: 10.1177/112067210901900205] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To study the cause, treatment, and cure of traumatic secondary glaucoma in 103 cases (103 eyes). METHODS The records of 103 patients (103 eyes) were reviewed. Causes of the high intraocular pressure (IOP) were analyzed according to the time after trauma. Most patients achieved a better visual acuity and ideal IOP after positive medical, neodymium:Yttrium aluminium garnet (Nd:YAG) laser, or surgical treatment. The operations included anterior chamber irrigation, filtering operation combined with mitomycin C, lensectomy, vitrectomy, and combination surgery. RESULTS Clinical findings of secondary glaucoma associated with ocular trauma are complex. Causes resulting in high IOP include intraocular bleeding, lens dislocation, phacoanaphylaxis, angle recession, and siderosis. After medical, laser, or surgical treatment, the IOP of most patients could be ideally controlled. After follow-up for half a year, the IOP of 3 cases (2.91%) was below 10 mmHg and 92 (89.32%) cases between 10 and 21 mmHg; only 8 cases (7.77%) still had IOP over 21 mmHg. CONCLUSIONS In traumatic secondary glaucoma, antiglaucoma medication should be used at the early stage, and surgery should be carried out when medical treatment does not reduce the elevated IOP, or in difficult cases to avoid severe complications. The postoperative IOP of most injured eyes was controlled within the safe range.
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Affiliation(s)
- Hai-Qing Bai
- Department of Ophthalmology, Affiliated Hospital of Medical College, Qingdao University, Qingdao - China.
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Lim HW, Ko MK. Change of Intraocular Pressure in Trabecular Meshwork Rupture Associated with Traumatic Hyphema. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.9.1501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Han Woong Lim
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
| | - Myung Kyoo Ko
- Department of Ophthalmology, College of Medicine, Hanyang University, Seoul, Korea
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Abstract
AIMS To review medical records of those patients managed by our department for retinal dialysis, and establish whether the initial assessment had been adequate to make the diagnosis. That is, to establish if an adequate initial assessment had been performed that would reasonably exclude the likelihood of retinal dialysis and other trauma-related sequelae such as angle recession. METHODS A retrospective review was made of all patients managed for retinal dialysis at Sussex Eye Hospital between 20 March 1997 and 20 September 2002 (66 months). In addition to general demographic data, surgical management and outcome, patient files were reviewed for history of trauma, prior ophthalmic review, and whether such review included documentation of peripheral retinal examination and gonioscopy. RESULTS A total of 580 primary procedures were performed for retinal detachment during the review period, of which 32 eyes of 29 patients underwent surgery for retinal dialysis (6%). There were 21 male and eight female patients, with a history of trauma obtained in 55% (17 eyes, 16 patients). Of the 16 patients with prior trauma, nine had undergone prior ophthalmic review at the time or soon after their trauma; however, only 2 (22%) had documented evidence of indented peripheral retinal examination. Only one (3%) patient in the whole series had documented gonioscopy. CONCLUSIONS Patients with history of trauma often present at the time or soon after their injury (eg hyphaema, orbital fractures). Thus, an opportunity exists to screen patients for known sequelae of trauma such as retinal dialysis and angle recession. It was disappointing to learn that this opportunity was not always being utilized, with some patients consequently developing macula-off retinal detachments and potential for reduced visual outcome.
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Affiliation(s)
- B J Vote
- Department of Ophthalmology, Sussex Eye Hospital, Brighton, UK
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Wong TY, Klein BEK, Klein R, Tomany SC. Relation of ocular trauma to cortical, nuclear, and posterior subcapsular cataracts: the Beaver Dam Eye Study. Br J Ophthalmol 2002; 86:152-5. [PMID: 11815338 PMCID: PMC1770991 DOI: 10.1136/bjo.86.2.152] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The consequences of minor ocular trauma in the general population are unclear. The relation of self reported ocular trauma to cortical, nuclear, and posterior subcapsular cataracts is described in a defined population. METHODS Population based, cross sectional study involving all people aged 43 to 86 years, living in Beaver Dam, Wisconsin (n=4926). Ocular trauma was ascertained by interview and cataract was graded from lens photographs. The relation of ocular trauma to cortical, nuclear, and posterior subcapsular cataracts was examined. RESULTS People with a history of ocular trauma were more likely to have cortical (odds ratio (OR): 1.5; 95% confidence interval (CI): 1.0 to 2.2) and posterior subcapsular (OR: 1.7; 95% CI: 1.0 to 3.1) cataracts, compared to people without a history of trauma. These associations were stronger for people with previous trauma caused by a blunt object (OR: 3.3; 95% CI: 1.6 to 6.9 for cortical cataract, and OR: 4.1; 95% CI: 1.5 to 10.8 for posterior subcapsular cataracts). However, in analyses comparing the frequencies of cataract between traumatised and non-traumatised eyes among people with unilateral ocular trauma, the ocular trauma association for cortical cataract was no longer present, although the association for posterior subcapsular cataract persisted (OR: 2.4; 95% CI: 0.8 to 7.8). CONCLUSION The data provide evidence of a possible association between self reported ocular trauma and posterior subcapsular cataract.
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Affiliation(s)
- T Y Wong
- Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, WI, USA.
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Manners T, Salmon JF, Barron A, Willies C, Murray AD. Trabeculectomy with mitomycin C in the treatment of post-traumatic angle recession glaucoma. Br J Ophthalmol 2001; 85:159-63. [PMID: 11159478 PMCID: PMC1723840 DOI: 10.1136/bjo.85.2.159] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM The presence of traumatic angle recession is a risk factor for failure of glaucoma filtration surgery and a previous study has suggested that antimetabolite treatment should be used in these patients. This study was undertaken to determine for the first time the mid term results of trabeculectomy with intraoperative application of mitomycin C in patients with post-traumatic angle recession glaucoma. METHODS A retrospective analysis was made of 43 consecutive trabeculectomy procedures in 41 young black/mixed race patients followed for a mean period of 25 months (range 2-66 months). Mitomycin C 0.02% was applied between the sclera and conjunctiva for 1-5 minutes at the time of surgery. The intraocular pressure and visual acuity were measured postoperatively. The success of this technique was analysed by using a Kaplan-Meier cumulative survival curve. RESULTS The intraocular pressure was successfully controlled at last follow up without topical treatment in 77% (33/43 eyes) and the visual acuity was the same or better in 81% (35/43 eyes). Cumulative probability of success was 85% at 1 year follow up, 81% at 2 years, and 66% at 3 years and thereafter. Hypotonous maculopathy occurred in one patient and no cases of late bleb infection were found. CONCLUSIONS In medically uncontrolled post-traumatic angle recession glaucoma trabeculectomy with mitomycin C is an effective surgical procedure with an acceptable complication rate. Good intraocular pressure control and preservation of vision can be expected in most patients.
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Affiliation(s)
- T Manners
- Department of Ophthalmology, Groote Schuur Hospital, Cape Town, South Africa
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Abstract
PURPOSE: To review the common causes of secondary glaucoma. METHODS: Review of current literature. RESULTS: Secondary open and closed angle glaucomas are an important cause of ocular morbidity and vision loss in our community. Secondary glaucoma occurs with acquired ocular diseases (pigment dispersion, pseudoexfoliation, intraocular infection, intraocular inflammation and retinal vascular disease), blunt anterior segment injury, intraocular surgery (especially corneal grafting and congenital cataract surgery) and topical corticosteroid use. The medical treatment of secondary glaucoma is different from that of primary open angle glaucoma and must be tailored for the individual patient. Surgical treatment of secondary glaucoma carries a higher risk of complications and a lower rate of success than does surgical treatment of primary open angle glaucoma. CONCLUSIONS: Secondary glaucoma occurs with a variety of intraocular conditions and after a variety of intraocular insults. Awareness of patients at high risk should enable early detection and referral for appropriate management.
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Affiliation(s)
- Anthony JH Hall
- Department of Opthalmology, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria, 3052, Australia
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