A long-term, often-missed sequela to closed globe injury is traumatic glaucoma. The incidence of traumatic glaucoma is bimodal, at 1 year and 10 years after injury.[1,2,3] This prospective study was designed to determine early predictors for the development of traumatic glaucoma.
Early Predictors of Traumatic Glaucoma After Closed Globe Injury: Trabecular Pigmentation, Widened Angle Recess, and Higher Baseline Intraocular Pressure
Sihota R, Kumar S, Gupta V, et al
Arch Ophthalmol. 2008;126:921-926
A total of 121 consecutive eyes were included in this analysis. Patients underwent initial evaluation and then 1-month, 360-degree goniophotography and anterior segment ultrasound biomicroscopy. Eyes with elevated intraocular pressure (IOP ≥ 21 mm Hg) for at least 3 months and requiring glaucoma therapy were diagnosed with traumatic glaucoma.
Of 92 eligible eyes, 40 (43%) were diagnosed with traumatic glaucoma. These subjects had intraocular injuries categorized at zone II (53%) or III (45%). Zone II was defined as anterior segment intraocular injury and zone III as posterior segment intraocular injury.
Hyphema, elevated IOP at time of injury, trabecular meshwork pigmentation, angle recession, and lens displacement were associated with the development of traumatic glaucoma.
This study demonstrates predictors for the development of traumatic glaucoma. Of note, most of these predictors are signs of significant intraocular damage, which makes sense. The one pathologic change not associated with traumatic glaucoma is cyclodialysis cleft; this may be protective against an increase of IOP. However, the authors did not comment on closure of the cleft; perhaps the risk for traumatic glaucoma would return with closure of the cleft.
Medscape Ophthalmology © 2008 Medscape
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