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Kelly Lee, Christopher Seery, Arkadiy Yadgarov, Albert S Khouri; Outcomes of Post-traumatic Glaucoma in Assault Injuries. Invest. Ophthalmol. Vis. Sci. 2016;57(12):3054.
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© 2017 Association for Research in Vision and Ophthalmology.
Traumatic ocular injuries can cause glaucoma, yet few studies have examined the outcomes in assault injuries. We performed a review to evaluate patient characteristics, prognostic factors, and outcomes in assault injuries resulting in glaucoma.
A retrospective review identified 200 patients with a confirmed diagnosis of traumatic glaucoma seen in 2009-2015 at University Hospital. Inclusion criteria were 1) patients intentionally harmed with malicious intent and 2) follow-up of at least one year. Exclusion criteria were trauma due to other causes (motor vehicle accident, falls, sports, other) and nonadherence to medications. Demographic and clinical data were recorded for: LogMAR visual acuity (VA), mechanism of injury, intraocular pressure (IOP), and number of glaucoma medications. Mechanism of injury was classified as blunt or penetrating. Overall success was an IOP of 6-21 at one year follow-up, further defined as absolute success (maintaining IOP with no medication) or qualified success (requiring medication). Failures were sustained pressures >21 or <6 in >3 visits, enucleation, or need for additional glaucoma surgery.
Nineteen patients met criteria (18 males, 1 female; mean age 42.8 years). Mean follow-up time since the trauma was 63 months. Physical assault (n=14) was the most common cause of injury (Table 1). 68.4% of the injuries were blunt compared to 31.6% penetrating. 42.1% required glaucoma surgery, such as tube shunts (87.5%) or trabeculectomy (12.5%). Twelve patients (63%) were overall successes with a mean IOP of 13.67 (p<0.05) at the 12-month follow-up. Five (41.7%) patients were absolute successes, while 7 (58.3%) patients were qualified successes. Seven patients were failures (37%) with a mean IOP of 30.57, even with glaucoma surgery and/or medication (Table 2). As for prognostic factors, initial IOP was outside the normal range of 6-21 (odds ratio 1.87 95% CI: 0.28-12.31) and presenting mean VA was worse at 2.05 or hand movements (odds ratio 4.29 95% CI: 0.39-47.63) in the failure group.
Post-traumatic glaucoma due to assault can be severe with significant loss of vision. However 63.2% were successfully controlled with treatment, and of those 41.7% were surgical successes. Visual prognosis is guarded but control of glaucoma is possible with surgical and medical interventions.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
Table 1. Causes of assault injury
Table 2. Clinical results at baseline and 12 months from initial presentation
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