Clinical Profile and Visual Outcome of Traumatic Glaucoma Patients Following Closed Globe Injury in the Rural Part of Eastern Uttar Pradesh at a Tertiary Eye Care Centre: A Retrospective Cohort Study

Abstract

Introduction: Glaucoma is a significant cause of ocular morbidity following ocular trauma, particularly Closed Globe Injury (CGI), which frequently leads to elevated Intraocular Pressure (IOP). This type of trauma can result in various tissue damages such as radial sphincter tears, iridodialysis, angle recession, cyclodialysis, trabecular meshwork tears, zonule separation, or peripheral retinal dialysis. Damage in these areas can lead to early or delayed onset glaucoma. Aim: To evaluate the clinical profile, assess visual outcomes, and analyse management strategies in post-traumatic glaucoma with CGI. Materials and Methods: The retrospective cohort study was conducted at a tertiary eye care centre in Department of Ophthalmology, Regional Institute of Ophthalmology (RIO), Sitapur, Uttar Pradesh, India. from January 2020 to December 2022. Retrospective data of patients presenting with CGI and developing elevated IOP (>21 mmHg) were collected. Only patients with a minimum follow-up of three months were included. Various parameters, including demographics, IOP, Best-Corrected Visual Acuity (BCVA), and the effects of medical and surgical treatments on IOP and BCVA, were analysed. The Ocular Trauma Score (OTS) was also calculated. Statistical analysis was performed using Microsoft excel and Statistical Package for Social Sciences software version 21.0, with a significance level of 5%. Continuous variables were described as mean±Standard Deviation (SD), and an unpaired t-test was used for comparisons between pre- and postmanagement visual acuity and IOP. Results: Out of 259 eyes with ocular trauma, 93 (35.90%) were diagnosed with CGI and developed elevated IOP. The most common causes of elevated IOP were hyphema (37.63%) and angle recession mechanisms (32.25%). The median IOP at presentation was 35 mmHg (range: 12 to 71 mmHg) and decreased to 16.5 mmHg (range: 4 to 52 mmHg) at the last follow-up (p-value <0.001). Surgical management was required in 30 (32.25%) eyes, with 13 (13.97%) eyes undergoing trabeculectomy. Conclusion: Post-traumatic IOP elevation occurred in 93 (35.90%) eyes with CGI, and 13.97% of these eyes required glaucoma filtering surgery for IOP control. Overall, medical management was necessary in 67.74% of eyes, while 32.25% required surgical intervention. Eyes with posterior segment involvement had poor visual acuity. Poor baseline vision and vitreo-retinal involvement increased the risk of a poor visual outcome.

Keywords

• angle recession
• hyphema
• oculartrauma score
• post-traumatic glaucoma
• trabeculectomy