Angle recession glaucoma

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.

Clinical outcomes of penetrating canaloplasty in patients with traumatic angle recession glaucoma: a prospective interventional case series

BACKGROUND/AIM

To evaluate the clinical outcomes of penetrating canaloplasty in traumatic angle recession glaucoma at 1 year.

METHODS

Patients with angle recession glaucoma underwent penetrating canaloplasty, a new Schlemm's canal-based internal drainage procedure, which creates a direct canal for flow of aqueous humour from the anterior chamber to the ostia of Schlemm's canal via a window created at the corneal scleral bed without use of antimetabolites. Postoperative intraocular pressure (IOP), number of glaucoma medications, and procedure-related complications were evaluated. Success was defined as an IOP ≤21 mm Hg without (complete) or with (qualified) use of glaucoma medication.

RESULTS

Forty eyes in 40 patients with angle recession glaucoma underwent successful circumferential catheterisation. The mean patient age was 42±13 years. In patients with penetrating canaloplasty that was deemed to be completely successful, the mean IOP decreased from a preoperative value of 37.8±12.3 mm Hg on 3.3±1.2 anti-glaucoma medications to 18.5±6.4 mm Hg on 1.2±1.4 medications, 14.9±4.6 mm Hg on 0.1±0.5 medications, 15.7±5.4 mm Hg on 0.1±0.4 medications and 14.8±3.6 mm Hg on 0.1±0.5 medications at 1, 3, 6 and 12 months postoperatively (p<0.05). Complete success was achieved in 35/40 eyes (87.5%) at 6 months and in 34/38 (89.5%) at 12 months. Hyphema (18/40, 45.0%) and transient IOP elevation (≥30 mm Hg, 9/40, 22.5%) were the most common postoperative complications.

CONCLUSION

Penetrating canaloplasty significantly reduces IOP and has a high success rate in angle recession glaucoma.

TRIAL REGISTRATION NUMBER

ChiCTR1900020511.

Evaluation of primary Ahmed Glaucoma valve implantation in post-traumatic angle recession glaucoma in Indian eyes

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.

Alles nur Spielzeug? Eine Untersuchung verschiedener Geschossspielzeuge hinsichtlich ihres Gefahrenpotenzials

Geschossspielzeuge wie die der Marke Nerf werden von der Allgemeinheit zumeist als harmlos und ungefährlich angesehen. In den letzten Jahren wurden die bunten Waffen ständig weiterentwickelt und verschießen mittlerweile Projektile mit Geschwindigkeiten von deutlich über 100 km/h. Unlängst wurde von Augenverletzungen im Zusammenhang mit Geschossspielzeugen dieser Art berichtet. Eine Untersuchung verschiedener auf dem Markt erhältlicher Modelle hinsichtlich ihrer ballistischen Eigenschaften sollte Aufschluss darüber geben, welche Gefahr von ihnen ausgeht. Sowohl die im Versuch ermittelten kinetischen Energien und Kontaktflächen der Geschosse als auch die ungleichmäßige Verteilung des Drucks beim Auftreffen lassen darauf schließen, dass Augenverletzungen im Umgang mit Geschossspielzeugen nicht auszuschließen sind.

Identification and Quantitative Assessment of Schlemm&#39;s Canal in the Eyes with 360&deg; Angle Recession Glaucoma

Synopsis

Angle recession, trabecular meshwork injury, increased trabecular pigmentation, and reduced Schlemm's canal dimensions can cause reduced aqueous outflow and unilateral glaucoma in an eye, following blunt trauma. Also, these patients are possibly at a risk to develop raised intraocular pressure (IOP) in the normal fellow eye due to reduced Schlemm's canal area.

Aim

To identify and quantitatively evaluate Schlemm's canal (SC) parameters by anterior segment optical coherence tomography (AS-OCT) in the patients with unilateral 360° angle recession glaucoma (ARG) and compare with the fellow normal eyes and age-related normal control.

Materials and methods

Six patients with a history of unilateral ocular blunt trauma and unilateral 360° ARG, normal fellow eyes and 34 age-matched normal controls underwent anterior chamber angle imaging with corneal line scan protocol using AS-OCT. Schlemm's canal cross-sectional area (SC-CSA) and meridional and coronal diameters were measured on temporal and nasal sections at 3 and 9 o'clock positions.

Results

In the AS-OCT cross-sectional images, SC was observed as a horizontally oval or ellipsoidal translucent space. The mean SC-CSA (1,710 ± 376.1 μm² vs 6,100 ± 2,700 μm², p < 0.0001), mean meridional diameter (243.6 ± 55.47 μm vs 474 ± 125.6 μm, p < 0.0001), and mean coronal diameter (32.68 ± 6.27 μm vs 57.42 ± 16.27 μm, p < 0.0001) of the SC were smaller in ARG eyes when compared with the normal eyes. The SC dimensions were reduced in the untraumatized fellow eyes of ARG patients when compared with the normal eyes (SC-SCA: 2350 ± 602.1 μm², p = 0.001, meridional diameter: 341.8 ± 88.8 μm, p = 0.012 and coronal diameter: 31.67 ± 3.8 μm, p < 0.0001). There was no difference in the measured SC dimensions between the ARG eyes and the normal fellow eyes.

Conclusion

The reduced SC parameters in the eyes with unilateral 360° ARG and the normal fellow eyes could mean that these patients probably have an underlying structural abnormality in the SC. Trabecular meshwork injury, angle recession, and increased trabecular pigmentation are probably the predisposing factors in the ARG eyes for the increase in IOP. Whether the normal fellow eyes develop IOP rise in the future needs to be seen during regular follow-up.

How to cite this article

Mansoori T, Reddy AA, Balakrishna N. Identification and Quantitative Assessment of Schlemm's Canal in the Eyes with 360° Angle Recession Glaucoma. J Curr Glaucoma Pract 2020;14(1):25–29.

Pathophysiology and management of glaucoma and ocular hypertension related to trauma

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.

Nerf gun eye injuries: traumatic hyphema

Three unrelated patients attended the accident and emergency department with pain and blurred vision after ocular injury with a Nerf gun. Two were adults and one was a child, all of which presented within a 3 months' period. All three cases were found to have ≥1 mm of traumatic hyphema (pooling of blood in anterior chamber of the eye), indicating significant ocular trauma. The two adult patients had formed hyphema and uveitis. The 11-year-old child had formed hyphema, corneal oedema, anterior uveitis, localised angle recession and commotio retinae, which further highlight the severity of the ocular trauma. Significant Nerf gun ocular injuries are not reported in the literature, as far as we know. This case series serves to raise awareness of the seriousness of Nerf gun ocular injuries. It encourages further exploration of reasons for such injuries, as well as a review of protective measures against ocular trauma.

Closed-globe injuries of the ocular surface associated with combat blast exposure

PURPOSE

To describe closed-globe conjunctival and corneal injuries and endothelial cell abnormalities associated with blast exposure and their relationships to other closed-globe injuries and blast-event characteristics.

DESIGN

Observational cross-sectional study.

PARTICIPANTS

Veterans with a history of blast-related traumatic brain injury (TBI).

METHODS

History and ocular examination, including slit-lamp biomicroscopy, gonioscopy, specular microscopy.

MAIN OUTCOME MEASURES

Type and location of blast injuries to the conjunctiva and cornea.

RESULTS

Ocular surface injuries were present in 25% (16 of 65) of blast-exposed veterans with TBI. Injuries included partial-thickness anterior stromal corneal scars (15 eyes), Descemet membrane ruptures (6 eyes), and conjunctival or corneal foreign bodies (7 eyes). Based on normative information from an age-matched comparison group, endothelial cell abnormalities were identified in 37% of participants. Eyes with ocular surface injury were more likely to have lower endothelial cell density, higher coefficient of variation of cell area, and lower percentage of hexagonal cells compared with eyes without injury. Presence of ocular surface injury or endothelial cell abnormalities was associated with elevated rates of other anterior and posterior segment injuries, as well as impairment of visual acuity. We found no relationship between ballistic eyewear use or severity level of TBI and presence of ocular surface injuries from blast.

CONCLUSIONS

Independent of TBI severity or use of protective eyewear, ocular surface injuries and endothelial cell abnormalities were found in significant numbers of veterans with blast-related brain injury. Descemet membrane ruptures from blast exposure were described. Ocular surface trauma was associated with other ocular injuries throughout the globe. Potential mechanisms for the types and locations of ocular injuries seen were discussed. Any corneal or conjunctival injury in a blast survivor should prompt a thorough ocular trauma examination, including gonioscopy and specular microscopy, with appropriate follow-up for associated injuries. Longitudinal studies are required to determine long-term visual outcomes after blast exposure.