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Jeffrey SooHoo, Emily McCourt, Rebecca Sands Braverman, Robert Enzenauer; Secondary Glaucoma and Pediatric Traumatic Hyphema. Invest. Ophthalmol. Vis. Sci. 2012;53(14):6781.
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To evaluate the incidence of secondary glaucoma requiring surgical intervention after traumatic hyphema in a pediatric population
This is a retrospective chart review of all patients seen in the emergency department at Children’s Hospital Colorado between July 1, 2009 and June 30, 2011 with a diagnosis of traumatic hyphema. The medical record for each patient was reviewed to determine the mechanism of injury and the incidence of secondary glaucoma or ocular hypertension following traumatic hyphema.
Forty-nine patients were identified as having traumatic hyphema. Ninety percent occurred in males with a median age of 10 years. Eight patients did not have initial IOP measurements recorded due to patient cooperation or concern for ruptured globe. Of the 41 patients remaining in the analysis, the mean intraocular pressure (IOP) at presentation was 21mmHg (range 10-50mmHg). Fourteen patients had elevated IOP (>21mmHg) at presentation and one developed elevated IOP during follow up. These patients were managed with topical and/or oral ocular antihypertensives or close observation at the discretion of the treating physician. Nine of these patients had normal IOP off medical therapy at one month following injury. The remaining 6/15 (40%) required prolonged treatment beyond one month after initial injury. Two patients (13%) required implantation of a glaucoma drainage device for glaucoma resistant to maximum tolerated medical therapy, both at less than 10 weeks after injury. The mechanism of injury for both patients that required surgical intervention was a metal projectile (BB) from an air-gun. IOP at presentation did not correlate with development of secondary glaucoma.
This is the first review to analyze the incidence of secondary glaucoma requiring surgical intervention after traumatic hyphema in a pediatric population. Initial IOP after injury did not predict the need for surgical intervention. Pediatric patients that sustain ocular injury with high-velocity projectiles warrant close follow up and may require surgical intervention for secondary glaucoma within the first few months after injury.
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