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

Abstract

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.

Keywords

• Closed globe injury
• incidence
• open globe injury
• outcomes
• pediatric
• post-traumatic glaucoma