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E.M. Happ, S. Kargi, F. Koc, A.W. Biglan, M.D. Gearinger; Traumatic glaucoma in children: Are there clues to management? . Invest. Ophthalmol. Vis. Sci. 2004;45(13):274.
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Introduction: Management of traumatic glaucoma in children is difficult and unpredictable. Many variables affect the course of this condition. By identifying variables associated with outcome, it may be possible to develop improved strategies for treatment. Patients/Methods: We conducted a retrospective review of 15 children who had ocular trauma before 16 years of age and developed glaucoma. Children with other causes for glaucoma were excluded. Glaucoma was defined as elevated intraocular pressures requiring medical or surgical treatment. The following parameters were analyzed to determine their effect on glaucoma control and visual acuity: aphakia or pseudophakia, age at injury less than 8, intraocular pressure above 40mmHg, rebleeding hyphema, recurrent trauma, globe rupture, onset of pressure maximum less than 1 week from injury and requirement for glaucoma surgery. Glaucoma control was defined as "good control" for patients with no progressive optic nerve damage or visual field defects and intraocular pressure measurements of 21mmHg or less on at least 2/3 of all office visits. Patients were considered to have "fair control" if the intraocular pressure was 22mmHg or higher on greater than 1/3 of measurements and "poor control" if there was progressive optic nerve cupping or glaucoma related visual field defects. Best corrected visual acuity was considered good if it was 20/40 or better, fair if 20/50 – 20/200, and poor if 20/400 or worse. Statistical analysis, using Fisher’s Exact Test, compared good control against a cohort of children who had fair and poor control. Results: An intraocular pressure over 40mm Hg, on any visit, independent of time of onset, was found to have a significant correlation (P=0.0014) with poor glaucoma control and resultant damage to the eye. The remaining parameters had no significant effect on glaucoma control. There was no correlation of any of the parameters with visual acuity. Conclusions: Variables such as: time of onset to maximum intraocular pressure, aphakia/pseudophakia, age at injury, recurrent injuries, rebleeding, globe rupture or requirement for glaucoma surgery do not play a significant role in control of glaucoma or alter visual outcome in children with traumatic glaucoma. Intraocular pressure greater than 40mmHg., at any time, was associated with glaucoma damage. These results suggest that the goal for treatment should be to keep the intraocular pressure below this threshold.
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