Globe rupture with aphakia, aniridia, secondary glaucoma and late corneal decompensation: A multi-staged approach to management

Severe blunt ocular trauma may result in immediate and delayed complications requiring appropriate management algorithms. We hereby report a case of globe rupture, aphakia, traumatic aniridia, and secondary glaucoma in a 33-year-old male following road traffic accident. He was treated initially by primary repair followed by novel combined approach of aniridia IOL with Ahmed glaucoma valve implantation. Delayed corneal decompensation required deferred penetrating keratoplasty. After a follow-up of 3.5 years after last surgery, patient maintains good functional vision with stable IOL, clear corneal graft and controlled intraocular pressure. A meticulously planned and staged management approach appears better suited in complex ocular trauma in such scenarios giving a good structural and functional outcome

Clinical features of early-onset pediatric traumatic glaucoma and predictive factors for the need of early glaucoma surgery

Purpose: To assess the clinical presentation of pediatric patients having early traumatic glaucoma and to analyze early predictors for the need of filtration surgery. Methods: Patients with early traumatic glaucoma after close globe injury (CGI) from January 2014 to December 2020 were retrospectively reviewed. Clinical features, treatment provided (medical and surgical), and visual outcomes were documented. Patients were divided into two groups based on the management required: group A? trabeculectomy and group B? medication + minor surgery. Results: A total of 85 patients were studied after applying the necessary inclusion and exclusion criteria. Out of these, 46 underwent trabeculectomy for the control of intraocular pressure (IOP) and the remaining 39 were managed with antiglaucoma medications. Significant male predominance of 9.6:1 was observed. Patients presented to the hospital after a mean duration of 8.5 days posttrauma. Wooden objects were most commonly responsible for trauma. Mean best corrected visual acuity at presentation was 1.91 log of minimum angle of resolution (logMAR). Mean IOP at presentation was 40 mmHg. The common anterior segment finding were severe anterior chamber (AC) reaction (63.5%), followed by angle recession (56.4%). Severe AC reaction (P = 0.0001) and corneal microcystic edema (P = 0.04) were significant predictive factors for early need of trabeculectomy. Conclusion: Need of trabeculectomy was higher in patients with severe AC reaction and corneal microcystic edema. The threshold to perform trabeculectomy should be lower, as glaucoma is often relentless, severe, and may result in irreversible vision loss.

Outcomes and risk factors for failure of trabeculectomy with mitomycin C in children with traumatic glaucoma - A retrospective study

Purpose: To determine surgical outcomes and risk factors for failure of trabeculectomy with mitomycin C (TMMC) in pediatric traumatic glaucoma. Methods: Children who underwent TMMC post trauma from January 2014 to December 2019 were reviewed. Demographic features, ocular findings, and surgery details were noted. Surgical success was defined as achieving intraocular pressure (IOP) within 6–21 mm Hg. Results: Seventy?one eyes of seventy patients underwent TMMC. The mean age of the patients was 11.28 ± 3.63 years with a male/female ratio of 13:1. The median time from trauma to IOP rise was 13 days. The majority of the patients (n = 64, 90.1%) had close globe injury. Baseline IOP was 39.3 ± 10.5 mm Hg. Results of the surgery were noted at the last visit. Cumulative success was noted in 51 (71.8%) eyes, while 20 (28.2%) eyes were labeled failures. Mean IOP reduced from 39.3 ± 10.5 to 14.5 ± 8.1 mm Hg. Mean visual acuity improved from 2.3 ± 0.93 to 1.19 ± 1.08 logMAR. Post surgery, the mean follow?up of the patients was 20.3 ± 11.4 months. Age <6 years (RR 3.6), elevated IOP at 1 month after TMMC (RR 2.19), and hypotony within a week of surgery (RR 1.81) were found as independent risk factors of surgical failure. Conclusion: TMMC is effective in reducing IOP in traumatic glaucoma. Young age and inability to control IOP within normal ranges in the immediate period after surgery are important risk factors of failure.

Incidence, clinical profile, and short-term outcomes of post-traumatic glaucoma in pediatric eyes

Purpose: To report the incidence, modes of injury, treatment, and short-term outcomes in eyes with post-traumatic elevated intraocular pressure (IOP). Methods: This was a 5-year hospital-based retrospective study of children ?16 years who presented with open (OGI) or closed globe injury (CGI) and developed elevated IOP >21 mmHg. Those with a minimum follow up of 3 months were included. Analysis of various parameters such as influence of demographics, mode of injury, IOP, best-corrected visual acuity (BCVA), and effect of medical and surgical treatment on IOP and BCVA was done. Results: Out of 205 pediatric eyes with ocular trauma, 121 (59%) had CGI and the remaining 84 (41%) had OGI. Thirty-two eyes (15.6%) developed elevated IOP. The incidence of elevated IOP following CGI [25 eyes (20.6%)] was significantly higher than that following OGI [7 eyes (8.3%, P = 0.02)]. Hyphema (37.5%) and lens-related mechanisms (18.75%) were the most common causes of elevated IOP. The mean IOP at the time of diagnosis was 29.8 + 6.3 mmHg and reduced to 16.2 ± 2.2 mmHg at last follow up (P < 0.001). Surgical management was required in 12 eyes (37%) and significantly more eyes with CGI required trabeculectomy (24% in CGI vs. 0% in OGI, P = 0.03). Poor baseline vision and vitreoretinal involvement [0.67 line decrement, 95% confidence interval (CI) =0.1–1.25 lines, P = 0.025] increased risk of poor visual outcome. Conclusion: Post-traumatic IOP elevation occurred in 15% pediatric eyes, was more common with CGI compared to OGI and nearly one-fourth of eyes with CGI required glaucoma filtering surgery for IOP control. Overall, medical management was needed in 63% eyes and 37% required surgical management. Visual acuity was poor in eyes with OGI due to posterior segment involvement.

Clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in treatment of traumatic glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To analyze the clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in the treatment of traumatic glaucoma, and to provide an effective treatment for improving the quality of life of patients with traumatic glaucoma. ·METHODS:Totally 90 patients (90 eyes) with traumatic glaucoma admitted in our hospital from January 2011 to July 2016 were divided into two groups (45 patients in each group) according to different treatment methods. The patients in the observation group underwent vitrectomy combined with cyclophotocoagulation under direct vision; the control group underwent vitrectomy combined with trans-scleral cyclophotocoagulation. We observed the effect of different treatment on visual acuity, intraocular pressure and complication of the two groups. ·RESULTS: The visual acuity of the observation group was significantly better than that of the control group after treatment (Z=-5.689, P<0.05). There was no significant difference on intraocular pressure between the two groups before treatment (P>0. 05). The change of decreased intraocular pressure in the observation group was less than that in the contral group after operation (P<0.05). After 1a follow-up,there was no significant difference on the change of decreased intraocular pressure between the two groups (P>0. 05). The complications of the two groups after treatment were vitreous hemorrhage, choroidal detachment, low intraocular pressure, increased intraocular pressure and other complications, but the complication rate of two groups were no different (x2=1.553,P=0.213).· CONCLUSION: Vitrectomycombinedwith cyclophotocoagulation under direct vision brings patients better visual acuity than that combined with trans-scleral cyclophotocoagulation.

Efficacy of two different treatments for secondary glaucoma after traumatic vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical efficacy of Ahmed drainage valve implantation and 23G cyclophotocoagulation for secondary glaucoma after traumatic vitrectomy.<p>METHODS: Totally 48 patients(48 eyes)with secondary glaucoma after traumatic vitrectomy were randomly selected from May 2014 to January 2016. According to the principle of random grouping, the patients were divided into experimental group and control group. Experimental group: 25 eyes were implanted with Ahmed drainage valve(25 eyes)and control group: 23G 532nm laser ciliary body photocoagulation(23 eyes). The intraocular pressure(IOP)and related complications were compared between the two groups. <p>RESULTS: The intraocular pressure control rate was 83%(19/23)in the experimental group and 72%(18/25)in the control group, the difference was no statistically significant(<i>χ</i>²=0.76, <i>P</i>=0.19). The postoperative complication rate was 39%(9/23)of experimental group at 1wk after operation. The overall complication rate in the control group was 68%(17/25), which was significantly higher than that in the experimental group(<i>χ</i>²=4.02,<i>P</i>=0.03). At postoperative 3mo, corneal endothelial cell density of two groups decreased, compared with the preoperative, the difference was statistically significant(<i>t</i>=4.22, <i>P</i><0.05), that of experimental group decreased by 13%, control group by 21%, with no statistical difference(<i>P</i>>0.05).<p>CONCLUSION: Ahmed drainage valve implantation and 23G cyclophotocoagulation are safe for the treatment of secondary glaucoma after traumatic vitrectomy. The operation is relatively safe, but 23G cyclophotocoagulation is more effective, for economic and practical, fewer complications.

Ex-press glaucoma shunt with adjunctive amniotic membrane and mitomycin C for post-traumatic glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To evaluate intraocular pressure (IOP) control and visual rehabilitation after placement of the Ex-press(R)miniature glaucoma shunt with adjunctive amniotic membrane transplantation (AMT) and mitomycin C (MMC) in patients with post-traumatic open-angle glaucoma during 2y of follow up.METHODS: This was an interventional,2-year,observational study.Eighteen eyes were prospectively observed (in 18 patients with traumatic secondary open-angle glaucoma) in which Ex-press miniature glaucoma filtration shunts were implanted with AMT and MMC.The outcome measures included intraocular pressure (IOP),best corrected visual acuity (BCVA),number of antiglaucoma medications,and complications.The progress of all patients was monitored for 24mo.RESULTS: Complete success (IOP <21 mmHg without glaucoma medications) was seen in 15 of the 17 (88.2%) eyes enrolled in the study at 24mo after the operation.IOP decreased from 36.9±4.8 mmHg preoperatively to 15.4±3.5 mmHg at 12mo and 15.5±3.5 mmHg at 24mo postoperatively.Early postoperative hypertension developed in two patients (11.1%) due to postoperative fibrosis.Most of the patients had improved postoperative BCVA values at the final follow-up visit compared to their preoperative measurements.Two patients (11.1%) developed transient hypotony.There were no complications such as hyphema,choroidal effusion,shallow anterior chamber,the device touching the iris,or extrusion of the device.CONCLUSION: The Ex-press miniature glaucoma filtration shunt with adjunctive AMT and MMC is effective and safe in cases of traumatic open-angle glaucoma.Surgical management is an appropriate surgical treatment in this series of cases.

Common clinical types and management of secondary glaucoma after ocular trauma / 国际眼科杂志(Guoji Yanke Zazhi)

?Ocular trauma related glaucoma is one of secondary glaucoma, which can lead to serious visual loss. According to the complex clinical findings and pathogenesis of ocular trauma related glaucoma, we divide traumatic secondary glaucoma into hyphema related glaucoma, angle recession related, lens injury related, adhesion and proliferation related. The treatment of secondary traumatic glaucoma with ocular trauma were different, specific treatment measures should be given according to the specific case to protect visual function.

The efficacy of Ahmed glaucoma valve drainage devices in cases of adult refractory glaucoma in Indian eyes.

Aim: To evaluate the efficacy of Ahmed glaucoma valve (AGV) drainage devices in cases of adult refractory glaucoma in Indian eyes. Settings and Design: Retrospective interventional case series study. Materials and Methods: Fifty two eyes of 32 patients of refractory glaucoma in the age group of 35 to 60 years who underwent AGV implantation with or without concomitant procedures from January 2003 to Jan 2007 were studied. Of these, 46 eyes (88%) had undergone filtering surgery earlier whereas remaining eyes underwent primary AGV implantation following failure of maximal medical therapy. The follow up ranged between 12 months to 48 months Results: Eighteen eyes (35%) had undergone phacoemulsification with AGV implantation, penetrating keratoplasty (PK) with AGV and intraocular lens (IOL) implantation in 13 eyes (25%), AGV over preexisting IOL in eight eyes (15%). AGV implantation alone was done in six (11%) eyes. Anterior chamber (AC) reconstruction with secondary IOL and AGV was performed in the remaining eyes. The mean intra ocular pressure (IOP) decreased from 36.3 ± 15.7 mm Hg to 19.6 ± 9.2 mm Hg. Complete success as per criteria was achieved in 46 eyes (88%). None of the eyes had failure to maintain IOP control following AGV. Conclusion: The AGV resulted in effective and sustained control of IOP in cases of adult refractory glaucoma in intermediate follow up.

Assessment of the trabeculectomy with 5 fluoruoracil in the treatment of post-traumatic glaucoma

Background: The post-traumatic glaucoma is a major cause inducing blindness of traumatic eyes. Recent, researches have shown that 5 fluoruoracil (5 FU) combined with surgery, which have a better result in treatment of general glaucoma and post-traumatic glaucoma. Objectives: To describe the clinical characteristics of post - traumatic glaucoma and assess the results of trabeculectomy with intra-operative application of 5 FU. Subject and methods: A descriptive, prospective analysis was taken on 32 patients, who had trabeculectomy with intra-operative application of 5 FU from August 2005 to December 2007 in the Traumatic Department of National Institute of Ophthalmology. Results: Post-traumatic glaucoma was seen mainly in young adults 71.9%; anterior angle recession combined lesions accounted for 25%; cataract 62.5%; fluid in anterior chamber 25%; anterior haemorrhage 37.5%. The intraocular pressure (lOP) was successfully controlled at least up to the following six months in 93.8% and the visual acuity was 0.02 and better in 62.5%. Conclusions: Trabeculectomy with antimetabolite therapy is an effective procedure in reducing IOP in post - traumatic glaucoma.