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A. S. Shah, A. V. Turalba, M. T. Andreoli, C. M. Andreoli, D. J. Rhee; Long-Term Outcomes and Risk Factors for Traumatic Glaucoma After Open-Globe Injury. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5322.
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The long-term (>6 months) history of traumatic glaucoma following open-globe injury (OGI) is not known. We report long-term outcomes and risk factors for the development of traumatic glaucoma following OGI.
We reviewed charts of all OGI patients who presented to the Massachusetts Eye & Ear Infirmary Eye Trauma Service between February 1999 and January 2007. During this period, patients underwent a standard clinical protocol for OGI repair. For our analyses, we included cases with ≥ 2 months follow-up, and we defined traumatic glaucoma as intraocular pressure (IOP) ≥ 22 mmHg at ≥ 2 measurements or as elevated IOP requiring treatment.
We identified 658 consecutive OGIs and found 382 with appropriate follow-up. Sixty-five of 382 patients (17%) developed traumatic glaucoma, and their mean follow-up was 20.6 months (range=2-102 months). Multivariate logistic regression identified increased age (p=0.001), hyphema (p=0.019), lens injury (p=0.000), and Zone II injury (p=0.025) as risk factors for traumatic glaucoma after OGI. Long-term data revealed that of the 65 patients, 5 (7.7%) had normalization of IOP without intervention, 48 (74%) were treated with medications alone, and 4 (6.2%) required anterior chamber washout in addition to medications. The remaining 8 (12.3%) underwent filtering or glaucoma drainage-device surgery; 5 of these required surgery within 6 months of OGI repair, and 3 required it within 2.25 years. Across all patients with traumatic glaucoma, average maximum IOP was 33.4 mmHg, and average last IOP was 15.6 mmHg. Forty-eight of 65 patients required no medications at last visit. Median visual acuity also improved from hand motions at presentation, to 20/60 at 1 year, and to 20/32 at 2 years.
Our data provide the first description of long-term management and outcomes for patients with traumatic glaucoma after OGI. The logistic regression model allows identification of patients at risk. The extensive follow-up shows that most patients can be treated successfully with medication, but surgery is a viable alternative. Most importantly, our data suggest a good overall prognosis for visual acuity and IOP with our treatment protocol.
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