A cyclodialysis cleft results from disinsertion of longitudinal fibers of the ciliary muscle from the scleral spur and underlying sclera, allowing direct communication between the anterior chamber and ciliochoroidal space and unrestricted bulk flow of aqueous from the anterior chamber to the supraciliary space. Exclusion criteria were an open globe injury, primary glaucoma or other preexisting cause of secondary glaucoma, and a history of ocular surgery or laser therapy. However, a portion of patients never recall a specific event despite other clinical signs of trauma such as iris sphincter tears or traumatic cataract. Sihota The mechanism of IOP elevation in ARG Challenging CTR. MTRafuse 2000 Feb;26(2):173-6. Collins ET. Book; 1991:117-125. Girkin All rights reserved. This article is from October 2010 and may contain outdated material. Girkin, et al. Iridodialysis is defined as the detachment of iris tissue from its root of attachment. Initially, gonioscopy may not are of the utmost importance. Early Predictors of Traumatic Glaucoma After Closed Globe Injury: Trabecular Pigmentation, Widened Angle Recess, and Higher Baseline Intraocular Pressure | Glaucoma | JAMA Ophthalmology | JAMA Network Angle recession was present in 93% of the eyes in our traumatic glaucoma group, but was also seen in 54% of those without glaucoma. The risk of developing angle-recession glaucoma appears to be related to the extent of angle recession. There are also limited data cited on IOP, the time when glaucoma was diagnosed, the extent of angle recession, and the use of glaucoma therapy in patients. Of course, the judicious use of steroid therapy with fast Angle recession is reported to occur in 20 to 94 percent of eyes after blunt trauma and is often masked initially due to the presence of concomitant hyphema, which results from shearing of the anterior ciliary arteries. Clues such as hyphema with or without an iridodialysis and/or cyclodialysis cleft should alert physicians that the trabecular meshwork has sustained damage. Ophthalmology 1993;100:634-642. A thorough ocular examination of both eyes was performed, including best corrected visual acuity, slitlamp biomicroscopic examination, fundus examination with a +90-diopter lens, and indirect ophthalmoscopy without indentation. chronic glaucoma following trauma.2. A 20-year-old black female presented for follow-up care after sustaining a blunt trauma injury to her right eye. A cyclodialysis is usually associated with a reduced IOP on initial examination, but IOP may increase spontaneously later with closure of the cyclodialysis cleft. FMorris Alper M. Contusion angle deformity and glaucoma. Interestingly, up to 50% of patients whose angle recession Correspondence: Viney Gupta, MD, Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India (gupta_v20032000@yahoo.com). because glaucoma is usually an asymptomatic disease. Br J Sports Med. Patients who are upset by the shape of their pupils or the appearance of their irises, or are suffering from any secondary effects from an additional iris opening, may be fit with large-diameter, painted/opaque contact lenses. In the presence of a hyphema, patients underwent evaluation more frequently to monitor the IOP and corneal status. The meticulous physician will also look for other abnormalities encountered with trauma, such as iris sphincter tears, mydriasis, iris atrophy, iridoschisis, iridodonesis, phacodonesis and a subluxated lens. There was no evidence of afferent pupillary defect; however, her right pupil had a pronounced D shape. Refraction improved her visual acuity to 20/25 O.D. Whats the most likely prognosis? Trans Am Ophthalmol Soc. How would you approach this case? from the blunt injury. unilateral angle-cleavage glaucoma. delay or may not seek medical attention. Selective laser trabeculoplasty has not been formally studied but is likely to also be ineffective. The longitudinal muscle The Video Journal of Cataract, Refractive and Glaucoma Surgery (VJCRGS) represents a lifelong mission of renowned ophthalmic surgeon and educator, Robert H. Osher, MD, to advance knowledge and surgical training of eye surgeons. Oyster CW. Forty consecutive eyes with closed globe injury and a chronically elevated intraocular pressure (IOP) of at least 21 mm Hg for a minimum of 3 months were diagnosed as having traumatic glaucoma and compared with 52 eyes with closed globe injury and no evidence of glaucoma. This has led to the hypothesis that angle recession does not directly cause elevated IOP, but may accelerate the process in an already at risk eye. Author Information Last Update: December 6, 2022. 9. On the other hand, the presence of a cyclodialysis was found to protect against the development of glaucoma (P<.001). Secondary glaucoma after trauma is more likely to occur with a closed-globe injury, but it is often underdiagnosed because its onset may be delayed and the history of eye injury may be remote or overlooked. Consecutive patients initially seeking treatment in the ophthalmic casualty department after concussive closed globe injury during a 1-year period were included for evaluation. G namely, angle-recession glaucoma (ARG). 2001 Feb;85(2):159-63. sooner than later to confirm angle recession. Iridodialysis is usually treated using sutures and can be combined with pupilloplasty to treat traumatic mydriasis. Other evidence of ocular trauma should clue the clinician to look for angle recession. Trans Am Acad Ophthalmol Otolaryngol. 2003 Jun;110(6):1082-8. 2004 Oct;30(10):2223-4. Glaucoma Today delivers important information on recent research, surgical techniques, clinical strategies, therapeutics, and technology. BTGrant deepening of the anterior chamber angle secondary to contusion. The city is located at . Trabecular pigment grades in 18 eyes with closed globe injuries and cleft were 4 in 1 eye, 3 in 5 eyes, and 2 or less in 12 eyes. What is your diagnosis? used the United States Eye Injury Registry to demonstrate that 3.39% of people go on to develop ARG at 6 months following blunt ocular trauma[8]. Mermoud A, Salmon JF, Barron A, et al. Feist RM, Farber MD. If pupillary block is present from lens dislocation, cycloplegics may be helpful until surgery is performed. Aqueous suppressants are preferred as initial IOP-lowering agents. Iridodialysis, sometimes known as a coredialysis, is a localized separation or tearing away of the iris from its attachment to the ciliary body. Intraocular pressure (IOP) measurements on at least 3 occasions were recorded by means of applanation tonometry. LDandona Light microscopy of the trabeculectomy specimens confirmed the presence of heavy pigmentation. of the Division of Ophthalmology and director The pertinent external/anterior segment findings O.D. The goals of initial assessment include recognition and characterization of the hyphema and identification of associated orbital and ocular injuries. Submitted for Publication: September 5, 2007; final revision received November 29, 2007; accepted January 8, 2008. for patients who experience angle recession, Iwase This patients low pressure resolved spontaneously and his vision returned to normal. 2006 Nov-Dec;37(6):508-10. [ 1] It commonly occurs after blunt and penetrating ocular trauma and complicated intraocular surgeries. The initial treatment of ARG is medical. form of traumatic glaucoma. On UBM, all 4 angle variables were found to be significantly greater in patients with traumatic glaucoma compared with those with closed globe injuries (P<.001) (Table 3). Iridodialysis is an avulsion of the iris from its natural attachment to the ciliary body at the iris root, the weakest part of the iris. A longer follow-up is necessary to see whether the IOP reduces with time or stays elevated and to see whether eyes in the closed globe injury group would develop glaucoma. Sihota R, Kumar S, Gupta V, et al. Surgical management of post-traumatic angle recession glaucoma. Intraocular pressure and facility of outflow late after ocular contusion. Alper MG. Contusion angle deformity and glaucoma. Gonioscopic appearance of an eye with traumatic glaucoma. For an elevated IOP, they were treated with -blockers, brimonidine, or dorzolamide hydrochloride topically and systemic antiglaucoma medications where necessary. The detection of post-traumatic angle recession by gonioscopy in a Ophthalmology. Iridodialysis is defined as a rupture of the iris at its thinnest area--the root. Angle recession was first described by Collins in 1892[3]. Salmon JF, Mermoud A, Ivey A, et al. 2006 May;17(3):438-41. However, she reported mild photophobia and pain upon right eye movement. NNAgarwal 2008;126(7):921926. Clinically, the presence of increased pigmentation at the angle, elevated baseline IOP, hyphema, lens displacement, and angle recession of more than 180 were significantly associated with the occurrence of chronic glaucoma after closed globe injury. To prospectively analyze the clinical and ultrasonographic biomicroscopy (UBM) features in eyes with closed globe injury, at the initial examination, that would predict the occurrence of chronic traumatic glaucoma during a 6-month follow-up. consequence of angle-recession blunt injury. : Sinauer Ass Inc.; 1999:411-46. 1994;101:1844-1850. recession with the clinical phenomenon of unilateral be possible, owing to iritis or pain. Careful lifelong monitoring of further subdivided Ophthalmologists must also be is a marker of significant injury, and the glaucoma is The median grade of trabecular pigmentation on gonioscopy in eyes with traumatic glaucoma was 3 compared with 2 in eyes without glaucoma (. who was masked to the patient's history and final diagnosis. WMPigmentary dispersion syndrome and pigmentary glaucoma: a prospective study of the natural history. Pathologically, the recession of the anterior chamber SAHoffman 21 A progressive enlargement of the original pupillary . The most commonly reported forms of trauma associated with ARG are recreational activities and assault[7]. Two other proposed mechanisms to explain the elevated pressures are. require a thorough slit-lamp examination and a careful, Ocular trauma may be classified as either blunt Dandona Iridodialysis, a Visually Significant Cataract, and Corneal Astigmatism. GLAUCOMA Figure 1. Br J Ophthalmol. Recession of the anterior chamber angle is a common slit lamp and gonioscopic finding following concussive ocular trauma. Jolla, California. Four patients with traumatic glaucoma had a recurrence of bleeding within 5 days of the trauma, compared with none of the patients with a closed globe injury. 8. The association between trauma and unilateral glaucoma was made by D'Ombrain in 1949[4]. Eye Trauma. This is typically seen about 100 days after the injury, and as such is sometimes called "100-day glaucoma". Vize CJ, Gauba V, Atkinson PL. Glaucoma after blunt trauma appears to have 2 peaks of incidence, at less than 1 year and about 10 years after trauma,5 by which time acute symptoms and signs of trauma have subsided and the patient is unaware of a chronically elevated IOP. Angle Recession; Aniridia; Iris Bombe; Neovascular Glaucoma; Peripheral Anterior Synechiae; Plateau Iris; Pupillary Block; Traumatic Iridodialysis; Open-Angle Glaucoma; Optic Nerve and Others; Surgery and Complications Ophthalmology 1985;92:904-911. The anterior chamber depth, superior and inferior angle measurement in degrees, angle opening distance at 250 and 500 m, and angle recess area were measured at the widest angle, with note of any other anterior segment abnormalities. By comparison, iridoschisis refers to splitting of layers of iris stroma. Sunderland, Mass. Arch Ophthalmol. Gracner The adjunctive use of antimetabolites can improve the success of trabeculectomy. Forty consecutive eyes with closed globe injury and a chronically elevated intraocular pressure (IOP) of at least 21 mm Hg for a minimum of 3 months were diagnosed as having traumatic glaucoma and compared with 52 eyes with closed globe injury and no evidence of glaucoma. 1963;69:77-89. Dr. Aleksej Medic. The iris body located adjacent to the separation becomes flaccid, which creates a flat, tensionless border. All Rights Reserved, Challenges in Clinical Electrocardiography, Clinical Implications of Basic Neuroscience, Health Care Economics, Insurance, Payment, Scientific Discovery and the Future of Medicine, 2008;126(7):921-926. doi:10.1001/archopht.126.7.921. Posterior segment examination will detect abnormalities that may also be present, and a dilated fundus exam should be performed after gonioscopy. Objective The mean number of topical medications at the start of therapy in the traumatic glaucoma group was 2.5 (1.2) and was reduced to 1.2 (1.0) at 3 months and 1.1 (0.2) at 12 months. diagnosis and aggressive intervention to lower the IOP These eyes, by virtue of the trauma, are vulnerable to glaucoma, thus avoiding secondary angle closure and preserving any . the trabecular meshwork has sustained damage. This membrane may be continuous with Descemets membrane and may extend peripherally into the recessed angle and onto the anterior surface of the iris. or penetrating. [PMC free article] [Google Scholar] Articles from Transactions of the American Ophthalmological Society are provided here courtesy of American Ophthalmological Society. The presence of a cyclodialysis was protective against the occurrence of chronic glaucoma on multivariate analysis. In general, angle-recession glaucoma is more difficult to control medically and surgically than other types of glaucomas. Later, ghost-cell glaucoma may develop from long-standing vitreous hemorrhage and a disrupted anterior hyaloid face or an open posterior capsule. 1968;46:886-889. JSports-related ocular injuries: a three-year follow-up study. Because there was no evidence of hyphema or active ocular bleeding, we advised her to use 600mg ibuprofen t.i.d. Blunt force indents the anterior aspect of the globe This initial insult may damage the TM and Schlemms canal leading to an early IOP spike. Early Predictors of Traumatic Glaucoma After Closed Globe Injury: Trabecular Pigmentation, Widened Angle Recess, and Higher Baseline Intraocular Pressure. Sihota Iridodialysis demonstrating a peripheral iris defect in the area of iris root disinsertion. Further, in the absence of a treatable, acute, secondary open-angle glaucoma, patients with a history of ocular blunt-force trauma should be assessed periodically for rising IOP to exclude a delayed traumatic effect on aqueous drainage.9-12 Baseline fields and photographs also may be included in the database, and repeated as necessary. All Rights Reserved. Resolution of uveal inflammation and injury is generally by a fibroblastic response, as seen in the iris or the choroid. Other signs include irregular and darker pigmentation in the angle, whitening of the scleral spur due to visibly fractured iris processes, or the presence of peripheral anterior synechiae. In some eyes, iris tissue blocks the cleft and prevents the development of hypotony. herein. In the traumatic glaucoma group, the respective numbers of patients were 5, 16, and 17 (P=.01). 2023 American Medical Association. Some normal eyes have a broad ciliary body band thus it is important to compare suspected areas of recession to the opposite eye to see what the normal ciliary body band looks like to avoid mistaking physiologic or even 360-degree recession as normal. Angle recession, with or without glaucoma, is a common sequela of blunt ocular trauma and one characterized by a variable degree of cleavage between the circular and the longitudinal fibers of. The extent of pigmentation was not related to the extent of angle injury alone, but was also probably a result of other ciliary body and iris damage. Cyclodestructive procedures 1. Ophthalmology. All Rights Reserved Privacy Policy, Cataract & Refractive Surgery Today Global | Europe Edition. Her best-corrected visual acuity was 20/30 O.D. A P<.05 was considered statistically significant. Traumatic hyphema, angle recession, dexamethasone hypertension, and glaucoma. ZGonioscopic changes caused by blunt eyeball injuries in sports [in German]. In: Oyster CW. The delayed onset of angle recession will cause a permanent elevation in IOP months to years after the initial blunt injury. Details of the ocular injurymode of injury, time from trauma to initial visit, and route, dose, and duration of therapywere recorded. their IOP and examinations of their optic nerves is recommended Blunt force to the globe causes an anterior to posterior axial compression with equatorial distension. Spaeth GL. Confrontational fields were normal. The consequent transient Other associated collateral injuries may include subconjunctival hemorrhage, ruptured globe, corneal abrasion, conjunctival laceration, hyphema, angle recession, increased intraocular pressure (IOP), lenticular subluxation, orbital bone fracture, blow-out fracture, retinal detachment, vitreous hemorrhage, choroidal rupture and optic nerve evulsion.4-6, Upon direct contact with an object or secondary to a sudden acceleration or deceleration, energy is perpetuated inside the eye by a hydraulic shock wave.7,8 This wave travels through the ocular media, transferring sufficient forces to the contrecoup region (area located 180 or directly opposite the site of impact) to detach the iris at its thinnest and most vulnerable location. 2. All patients were followed up every month for 6 months and as appropriate thereafter. Zone 2 injuries involved structures in the anterior segment up to and including the lens apparatus, the lens zonules, and the pars plicata. . In the acute setting, treatment should be directed at lowering IOP and controlling inflammation. The membrane obstructs aqueous outflow, causing an open-angle form of glaucoma. Trabeculectomy with mitomycin C in the treatment of post-traumatic angle recession glaucoma. such as hyphema, iridodialysis of the iris root, and/or Post-traumatic angle recession glaucoma risk factor for bleb failure after trabeculectomy. 1962; 54:547-550. Because the consequence of angle recession and late or post-traumatic glaucoma exists in all patients who sustain ocular blunt trauma, the entire angle in both eyes (for comparison) should be inspected with gonioscopy following the repair of and recovery from all acute sequellae.12 (Take note that gonioscopy always should be performed, irrespective of visible iris damage.) and revealed the presence of mild myopia. In 1792 . Trabecular pigmentation of at least grade 3 was seen in 7 eyes (13%) in the closed globe injury group and in 36 (90%) in the traumatic glaucoma group, correlating significantly with the presence of traumatic glaucoma (r2=0.64; P<.001). typically used to treat open-angle glaucoma sometimes Angle recession glaucoma are generally more difficult to control medically and surgically than other types of glaucomas. Frying Pan to the Fire. Moreover, glaucoma-related codes that indicate identifiable factors (e.g., pigment dispersion in pigmentary glaucoma, pseudoexfoliative material of pseudoexfoliation syndrome, and steroid-induced glaucoma), suspected glaucoma, ocular hypertension, steroid responders, anatomical narrow angle, and pre-glaucoma were excluded from the current study . . Eye injury as a result of coat toggle trauma. On the pathological examination of three eyes lost from concussion. After the trauma occurs, elevated IOP may be secondary to obstruction of the trabecular meshwork by red blood cells, inflammatory cells or pigmented cells. The latter group The median grade of trabecular pigmentation on gonioscopy in eyes with traumatic glaucoma was 3 compared with 2 in eyes without glaucoma (P=.001). IOP may rise immediately after the injury, as a result of associated comorbidities such as hyphema, iridocyclitis or pupillary block from ectopia lentis (with or without vitreous prolapse). Zone 3 injuries were posterior injuries involving the pars plana, choroid, retina, vitreous, or optic nerve. The elevated IOP at baseline probably reflects decreased aqueous outflow due to extensive primary damage, inflammation, and pigment release at the trabecular meshwork. Eur J Ophthalmol. JABarros Histopathological evaluation of the trabeculectomy specimens was performed in eyes that underwent filtering surgery. The insult occurred approximately one month earlier. et al. Interestingly, one study reported 50% of ARG patients will go on to develop open angle glaucoma in the contralateral eye[11]. In the event that late or post-traumatic glaucoma becomes evident, it can be treated using the same algorithm as primary open-angle glaucoma. Detachment of the iris root from its insertion site at the ciliary body results in iridodialysis. The Academy uses cookies to analyze performance and provide relevant personalized content to users of our website. Mermoud et al compared standard trabeculectomy, As suggested A gonioscopic examination reveals a deepening of In the traumatic glaucoma group, the mean IOP was 20.4 (4.1) mm Hg and 18.7 (4.8) mm Hg at 3 and 6 months, respectively. to be posteriorly displaced. She returned for her scheduled seven-day follow-up, and exhibited complete resolution. Girkin, C., McGin, G., Long, C., Morris, R., and Kuhn, F. Glaucoma After Ocular Contusion: A Cohort Study of the United States Eye Registry. Tonjum AM. Angle-Closure Glaucoma. 1927; 25:160-167. All patients with concomitant posttraumatic uveitis were treated with corticosteroids for a maximum of 2 weeks. Glaucoma, secondary to angle recession, can occur months to years after the initial injury and . The lifetime prevalence of ocular trauma is estimated to the director of glaucoma and cataract, and the codirector of the International Division for the John A. Moran Eye Center at the University of Utah in Salt Lake City. Numerous techniques are used to . Angle recession is also strongly associated with traumatic hyphema with studies reporting a 60-100% incidence [6]. Argon laser trabeculoplasty in secondary form of open angle glaucoma. Eleven eyes in the traumatic glaucoma group required trabeculectomy for control of IOP. The limbus and the anterior chamber. He acknowledged no financial 1892;12:180-183. Such a reparative process in the ciliary body would necessarily involve the adjoining trabecular meshwork, decreasing aqueous outflow and raising IOP. AIvey Abrupt indentation of the cornea forces posterior and lateral displacement of aqueous humor, deepening the peripheral anterior chamber and increasing the diameter of the corneoscleral limbal ring. Six patients in the closed globe injury group and 2 in the traumatic glaucoma group were lost to follow-up at 6 months. patients with uncontrolled ARG.12 Trabeculectomy with When gonioscopy is performed, asymmetry of the angle recess may be noticeable between the affected and the nontraumatized eye or in different quadrants of the involved eye. CURichardson Because iridodialysis involves the traumatic (injurious or surgical) dissection of well-vascularized and innervated iris tissue, an accompanying inflammatory response (secondary iridocyclitis) and bleeding (hyphema) should be expected.12 Topical cycloplegics, such as atropine 1% dosed q.d. Intraocular pressure and facility of outflow late after ocular contusion. 6. and rapidly transmits massive energy throughout the Prostaglandin analogs have a theoretical benefit of bypassing the dysfunctional trabecular meshwork by increasing uveoscleral outflow. : Sinauer Ass Inc.; 1999:379-410. Post-traumatic glaucoma with irido-corneal angle injuries in Cameroon. Dr John Davis Akkara (MBBS, MS, FAEH, FMRF), https://eyewiki.org/w/index.php?title=Angle_Recession_Glaucoma&oldid=90006, Loss of tension of ciliary muscle on the scleral spur thus narrowing Schlemms canal, A hyaline membrane has been reported to grow across the trabecular meshwork which may be another mechanism to explain decreased aqueous outflow, Secondary surgery following intraocular surgeries, One should also consider causes of asymmetric glaucoma, such as, Examples of angle recession are available through on, Excellent review article by Tumbocon and Latina. relating to aqueous outflow. The patient explained that she had exhausted her supply of eye dropsone with a red cap and one with a white capand that her right eye felt achy. facility, measured by tonography, is reduced and correlates nguyen.quang@scrippshealth.org. Ocular blunt trauma: loss of sight from an ice hockey injury. The relative risk of developing chronic glaucoma in an eye with closed globe injury, based on clinical features seen at presentation, was greatest if there was heavy pigmentation of the trabecular meshwork, an elevated baseline IOP, hyphema, angle recession, and lens displacement with a cataract (Table 4). MThe detection of post-traumatic angle recession by gonioscopy in a population based glaucoma survey. Although different underlying mechanisms may be involved with the initial injury, the resulting optic neuropathy and visual field loss is secondary to elevated IOP from reduction in aqueous outflow through the trabecular meshwork. JrLong Via Ferrata en Rhne-Alpes - Trouvez rapidement votre prochaine sortie : tri, critres de recherche, mais aussi le matriel ncessaire, les techniques de progression, les consignes de scurit. Diagnostic Data This peripheral anchor, which connects the iris to the ciliary body/muscle, is known as the iris root.8 As the tissue becomes freed, it creates an alternate, oval pupil that is confined by its points of attachment. Widening of the ciliary body band may be present due to retrodisplacement of the iris root. appears to be a decrease in aqueous filtration. RCPavlin It can be Ocular findings are listed in Table 2. Figure 2, exaggerated widening of the ciliary body face is Medication. In 1 eye, a cyclodialysis cleft was noted, associated with angle recession. Mermoud A, Salmon JF, Straker C, et al. Approximately 5 to 20 percent of eyes with angle recession develop angle-recession glaucoma. Accessibility Statement, Our website uses cookies to enhance your experience. Gonioscopy may aid in the diagnosis of other angle abnormalities from trauma, such as iridodialysis or cyclodialysis. The Prostaglandin analogues should be avoided in the acute phase of trauma because of their potential to be pro-inflammatory. The peripheral iris has fallen away from the spur, leading to a very wide angle and a large distance from the scleral spur to the iris root (white arrow). 3. In the 14th century the counts of Savoy made Chambry their capital. Because the trabecular meshwork also is susceptible to the hydraulic effects of the shock wave, it too may incur damage, altering aqueous egress either acutely or on a delayed timeline.9,10 Cases of iridodialysis involving more than 180 pose a greater statistical risk for the late glaucomatous development.11. Forty of the 92 patients (43%) had a persistent elevation of IOP (21 mm Hg) for at least 3 months, ie, traumatic glaucoma. An angle recession was detected in 31 eyes, including 8 with an angle recession of less than 180; 10, of 180 to 270; and 13, of more than 270. 14. antimetabolites was the most effective at controlling the Demographic data are presented in Table 1. J Cataract Refract Surg. the next crucial step. Resolved iridodialyses that neither require surgical repair nor produce ill-cosmetic effects require no additional ophthalmic management. Glaucoma drainage devices have demonstrated some benefit, but their success rates are lower in angle-recession glaucoma than with other types of glaucomas. Now I am studying the master STAPS "Ingnierie et Ergonomie de l'Activit Physique" (IEAP) in the Universit Savoie Mont Blanc in . A review of data from the US Eye Injury Register found increasing age, poor baseline visual acuity, angle recession, hyphema, and lens injury to be independent risk factors for developing posttraumatic glaucoma.6 Posttraumatic glaucoma was recorded at any time within 6 months of the injury, based on the physicians' opinion alone. A binary logistic regression analysis was used to determine the relative risk of developing glaucoma, as evidenced by baseline clinical features and UBM findings. DOmbrain. Clues such as hyphema with or without an iridodialysis Only sclera, with a cleft between it and the uveal tissue, is seen to the left of the scleral spur for a few millimeters (ie, the cyclodialysis). Iridodialysis occurs after blunt trauma when the iris root becomes disinserted from the sclera (Figures 5 and 6). Several publications have demonstrated that the greater the number of clock hours of angle recession, the greater the likelihood of developing elevated pressures and glaucoma. 2 Once the acute inflammation and hyphema resolve, attention should be paid to the anterior chamber depth of the affected eye, which may appear deeper. Drs. Findings on UBM of a large angle opening distance at 250 m, an angle recession area, and a wider distance from the scleral spur to the iris root also predicted chronic glaucoma. Manners, T., Salmon, JF, Barron, A., Willies, C., Murray, ADN. The higher prevalence of glaucoma after closed globe injury in our study patients was because our institution is a tertiary referral center and probably examines more severely traumatized eyes. Further, the aggressive use of topical steroidal and nonsteroidal anti-inflammatory preparations can be employed to reduce the incited immune response.
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