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·AIM: To study the influence of Ahmed glaucoma valve implantation on eyesight, intraocular pressure and corneal endothelial cell density of patients with traumatic angle recession glaucoma. ·METHODS: Totally 33 cases (35 eyes) of patients with traumatic angle recession glaucoma admitted to our hospital since June 2014 to June 2016 were selected and treated with Ahmed glaucoma valve implantation. The clinical data of all patients were retrospectively analyzed, so as to evaluated to success rate of surgery. Non-contact tonometer was applied to surveying intraocular pressure before treatment and at 1wk, 1,3,6mo and 1a post treatment. Specular microscope was adopted to examine and calculate the corneal endothelial cell density before treatment and at 1wk, 1, 3, 6mo and 1a post treatment. All affected eyes were compared for visual acuity before surgery and in 1a after surgery, moreover, patients were followed - up, received the further consultations and the complications were recorded. ·RESULTS: As for 35 affected eyes, the absolute success rate of surgery was 54% , while the relative success rate was 40% , and the total successful rate and failure rate were 94% and 6% respectively. In terms of the number of people who had no light sensation before surgery, or who had light sensation, ≤0. 01, 0. 01-0. 10 or >0. 10-0. 20, there was no significant difference (Z=-0. 132, P=0. 362). The intraocular pressure before treatment was 43. 43 ± 3. 65mmHg, at 1wk after surgery was 13. 50 ± 2. 54mmHg, at 1mo was 15. 93 ± 2. 61mmHg, at 6mo was 16. 00 ± 2. 18mmHg and at 1a was 16. 45 ± 2. 21mmHg, and the difference among different time points had statistical significance (F= 887. 82, P<0. 01). After treatment the intraocular press decreased compared to before treatment (P<0. 05); those after treatment had no difference with each other ( P> 0. 05 ). Before treatment, the corneal endothelial cell density was 2443. 35 ± 343. 12 pieces/mm2, in 1wk after the surgery was 2231.67±334.45 pieces /mm2, in 1mo after the surgery was 2065. 47 ± 336. 45 pieces /mm2, in 3mo after surgery was 2031. 47 ± 345. 76 pieces/mm2, in 6mo was 2001. 72±337. 18 pieces /mm2and in 1a after the surgery was 1979. 65 ± 301. 32 pieces /mm2, and the difference among different time points had statistical significance ( F = 13. 49, P<0. 01 ). After treatment the corneal endothelial cell density decreased compared to before treatment (P<0. 05); those after treatment had no difference with each other (P>0. 05). After surgery, there were 4 cases (4 eyes) of ocular hypotension, 3 cases (3 eyes) of hyphema, 2 cases ( 2 eyes) of drainage tube plugging and 2 cases ( 2 eyes ) of intraocular hypertension, which were all quickly relieved after basic intervention treatment. · CONCLUSION: Treating traumatic angle recession glaucoma with Ahmed glaucoma valve implantation can dramatically optimize the state of intraocular hypertension and protect the retaining visual acuity, and visual acuity can be optimized in some cases. It causes little complication that can be relieved with basic prognosis, but postoperative corneal endothelial cell loss exists in some cases.
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Objective To evaluate the clinical efficacy of combined pilocarpine eye drops in the treatment of traumatic angle recession glaucoma.MethodsThe clinical data of the patients were collected and analyzed retrospectively.The data collection time was December 2015 to December 2016.Were randomly divided into two groups according to the time of admission, the control group (38 cases) received routine treatment, the observation group (40 cases) treated with conventional therapy combined with pilocarpine eye drops.The IOP and pupil diameter of two groups were observed and compared.ResultsAfter treatment, two groups of patients with intraocular pressure were significantly decreased, compared with the group before treatment, there were statistically significant differences, and different time after the treatment were compared between the observation group were significantly lower than the control group, the difference was significant (P<0.05);after two 7d of treatment group were significantly reduced compared to the diameter of the pupil.Compared with the group before treatment, there were statistically significant differences, and different time after the treatment were compared between the observation group were significantly less than the control group, the difference was significant (P<0.05);efficiency evaluation results of two groups under different treatment, the observation group treated a total of 21 cases invalid, only 2 cases, the total effective rate was 95.00%, and there was no statistic difference between control group (P<0.05).ConclusionThe conventional therapy combined with pilocarpine eye drops on injury caused by angle recession glaucoma patients for treatment can significantly reduce intraocular pressure, miosis, improve efficiency.
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Traumatic glaucomas are a very heterogeneous group of entities due to a variety of mechanisms which increase the intraocular pressure in the early or late phase after traumatic injury. Glaucoma after closed globe injury is a major concern because many cases may go unnoticed and are diagnosed many years later as having irreversible glaucomatous optic nerve damage.[1,2] Angle recession is one of the causes for late onset posttraumatic glaucoma; this condition may be underdiagnosed because the onset is often delayed and because a history of eye injury may be distant or forgotten.
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Complicated glaucomas present considerable diagnostic and management challenges. Response to treatment can be unpredictable or reduced compared with other glaucomas. However, target intraocular pressure and preservation of vision may be achieved with selected medical, laser and surgical treatment. The evidence for such treatment is expanding and consequently affords clinicians a better understanding of established and novel techniques. Herein we review the mechanisms involved in the development of complicated glaucoma and the current evidence supporting its management.