Incidence and risk factors for traumatic intraocular pressure elevation and traumatic glaucoma after open-globe injury

Abstract

Purpose To examine traumatic intraocular pressure (IOP) elevation and glaucoma after open-globe injury. Design Retrospective, observational case series. Methods Review of patients with open-globe repair at the University of Washington from May 1997 through July 2010. Traumatic IOP elevation and glaucoma were defined respectively as intraocular pressure (IOP) ≥ 22 mm Hg at 41 visit or need for glaucoma medication, and long-term (at least 3 months) glaucoma medication use or glaucoma surgery. Results We included 515 eyes (515 patients). The mean follow-up was 12.6 ± 20.1 months. One hundred twenty eyes (23.3%) developed traumatic IOP elevation, of which 32 (6.2%) developed glaucoma; six eyes (1.2%) required glaucoma surgery. The mean time to development of traumatic IOP elevation was 1.5 ± 3.4 months (range 1 day to 2 years). Kaplan-Meier 6-and 12-month estimates for development of traumatic IOP elevation were 27.2 and 32.4%, respectively, and for development of traumatic glaucoma were 7.1 and 11.0%, respectively. Multivariate regression revealed associations between traumatic IOP elevation and older age, and traumatic glaucoma and prior penetrating keratoplasty, initial vitreous hemorrhage, Zone II injury, and penetrating keratoplasty after open-globe repair. Traumatic glaucoma was controlled (IOP o22 mm Hg) in 78.1% of eyes at final follow-up, with mean IOP of 18.2 mm Hg on 1.7 medications. Conclusions Traumatic IOP elevation and glaucoma were common after visually salvageable open-globe injury. Most cases developed within 6 months, although longer follow-up remains important for case detection. Penetrating keratoplasty before or after repair, and vitreous hemorrhage were notable risk factors.

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“…Pre-existing secondary glaucoma is a common problem in traumatized eyes, especially in patients with traumatic aniridia [6]. In our series it was present in 60% of our patients.…”

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“…According to Bojikian et al, traumatic IOP elevation and glaucoma are common after visually salvageable open-globe injury. Most cases develop within 6 months, although longer follow-up remains important for case detection [ 13 ].…”

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