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Hampton Addis, Samantha Uhlfelder, Jordan Margo, Osamah Saeedi; Ruptured Globe injuries presenting with high IOP associated with poor visual outcomes. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):6046.
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Ocular trauma is the leading cause of monocular blindness and a common cause of disability. Low intraocular pressure (IOP) is considered a reliable clinical predictor of open globe injury. However, open globe injury with high IOP has been reported. The goal of this retrospective study was to determine the frequency, clinical characteristics and visual outcomes of patients that present with high IOP and open globe injuries. We hypothesize that there is a significant subset of patients that have high IOP in the setting of globe ruptures and that the visual outcomes in these patients are poor.
A retrospective chart review was performed on globe ruptures presenting to the University of Maryland between 2005 and 2014. Demographics, physical examination, including IOP of the affected and un-affected eye, and follow-up evaluations were analyzed. A masked trauma radiologist re-reviewed available CT scans based on pre-determined radiographic findings. IOP was measured as a continuous variable and univariate and multivariate analyses were performed to determine 1) IOP association with clinical and radiographic variables and 2) predictors of poor visual outcomes.
Of 132 eyes presenting with globe rupture, 37 (28%) had IOP recorded. Mean IOP for the affected and unaffected eye were 14 +/- 10.3 mmHg, (range 0-44mmHg) and 16.6 +/- 4.1 mmHg (range 8-16 mmHg), respectively. Six eyes (16.2%) had IOP greater than 21 on presentation. All had uveal prolapse on examination, vitreous hemorrhage on CT scan and a final outcome of no light perception vision. On univariate analysis, risk factors for high IOP included posterior rupture on physical examination (p=0.046), posterior hemorrhage (p=0.025) and intraconal retrobulbar hemorrhage (p=0.035) on CT scan. Final visual acuity light perception or worse vision was also associated with high IOP (P=0.006). On multivariate analysis, high IOP was associated with posterior rupture (p=0.042), and final visual acuity of LP or worse was associated with high IOP (OR =1.49, p=0.049)
High intraocular pressure is a frequent finding in patients with ruptured globe injuries and is a poor prognostic factor. High IOP is more likely in patients with posterior rupture and posterior intraocular hemorrhage or intraconal hemorrhage on CT Scan.
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