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August L. Stein, Mark A. Slabaugh, Philip P. Chen; Post-Traumatic Glaucoma Following Open Globe Injury: A Retrospective Chart Review. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5616.
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The ophthalmic literature contains multiple studies examining risk factors for post-traumatic glaucoma following blunt ocular injury. These well established risks include hyphema, corneal injury, angle recession, iridodialysis and poor initial vision. Few studies, however, have examined the risk and incidence of glaucoma following open globe injury. We reviewed such injuries presenting to a single county hospital over a three year period.
This is a retrospective review of patients with a CPT code for ruptured globe from January 2007 through July 2010. Factors were recorded including basic demographics, mechanism and type of injury, initial vision, presence of APD, hyphema, lens injury, iris injury, need for further procedures, and IOP at all follow-up visits. Glaucoma was defined as IOP >22 in the affected eye on two consecutive visits, need for medical or surgical treatment to reduce IOP, or development of characteristic optic nerve or VF abnormalities. Statistical analysis was performed using SPSS.
76 eyes of 75 patients met criteria for evaluation, including >90 days of follow-up and no enucleation. 18 eyes of 18 patients (23.7%) developed glaucoma, with 2 eyes in 2 patients requiring glaucoma surgery. The only statistically significant risk factor (p<0.05) was the need for penetrating keratoplasty (p=0.03), with corneal involvement of the wound (p=0.09) as approaching but not reaching statistical significance.
Our study found a glaucoma incidence of 23.7%, with the only significant risk factor being requirement of a corneal graft. This is potentially confounding as the keratoplasty procedure itself is associated with the development of glaucoma. This rate of glaucoma is higher than previously published data. These findings highlight the importance of close long term follow up to avoid preventable blinding complications that arise in patients suffering this type of injury. Larger case numbers are needed to identify further risk factors for glaucoma development after penetrating trauma and review is ongoing.
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