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Kunjal Modi, Arkadiy Yadgarov, Dan Liu, Albert S Khouri; Success of Tube Surgery for Blunt Trauma Related Glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):6496.
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© ARVO (1962-2015); The Authors (2016-present)
After trauma, factors such as posttraumatic inflammation, presence of blood, and injury to the trabecular meshwork increase intraocular pressure (IOP). Some of these patients have uncontrolled IOPs, necessitating surgical intervention. As non-penetrating trauma often follows a very different course and prognosis compared to penetrating injury, our study chose to examine non-penetrating, or blunt injury. Specially, the purpose of this study was to assess the success of tube surgery after blunt trauma related glaucoma, as measured by decrease in IOP and medication burden.
A review was conducted of patients who had traumatic glaucoma secondary to blunt injury, necessitating tube surgery, at the University Hospital in Newark, NJ, from 1997-2013. Initially, medical records of all patients with trauma-associated glaucoma were reviewed. Patients were included if they had blunt trauma associated glaucoma, and required tube surgery to control IOP. Patients were excluded if their trauma involved any mechanism aside from blunt injury, if post-op follows up was lost prior to 3 months, or if they did not have adequate record of their pre and post-op medication regimen. Pre-operative and post-operative IOP and medication burden were compared using a two-sample equal variance t-test.
An initial list of 94 patients was reviewed. After exclusion criteria, 17 patients were selected for inclusion. Mean age of participants was 38.8 years, 3/17 (17.6%) were female, and presenting visions ranged from 20/80 to LP. Five of 17 patients (29.4%) required other ocular surgeries in addition to the tube.Table 1 (attached) shows that IOP was statistically significantly lowered during all follow up periods, and medication burden did decrease, reaching statistical significance at 3 of the 5 follow up periods.
In this trial, tube surgery did show successful outcomes after blunt trauma related glaucoma. Compared to pre-operative, the maximum decrease in IOP was 24.65 mm Hg, and the maximum topical drop burden decreased by 2.21 drops per day. Persistently elevated IOP and unsustainably high medication burden both lead to poorer outcomes. Therefore, it may be reasonable to consider tube surgery early in the post-blunt trauma period for patients with elevated IOPs, who have an unsustainable pressure-lowering medication burden.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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