remains attached to the scleral spur (Figure 1). Traumatic hyphema, or blood in the anterior chamber, is a common complication of blunt or penetrating injury to the eye and can result in permanent vision loss. namely, angle-recession glaucoma (ARG). If pupillary block is present from lens dislocation, cycloplegics may be helpful until surgery is performed. Arch Ophthalmol. as the use of steroid therapy, can further complicate the They treated the patient using 3 Hoffman pockets for iris and IOL fixation to the sclera while reducing conjunctival trauma. Mermoud et al compared standard trabeculectomy, Damage of the trabecular meshwork and peripheral anterior synechiae may cause IOP elevation. In 1962, Wolff and Zimmerman astutely connected Glaucoma drainage devices have demonstrated some benefit, though their success rates are lower than with other types of glaucomas. of developing glaucoma. The goals of initial assessment include recognition and characterization of the hyphema and identification of associated orbital and ocular injuries. Ultrasonographic biomicroscopy allowed us to objectively identify and delineate angle recession and other features in traumatized eyes. Nonappositional repair of iridodialysis : Journal of Cataract Your Diagnosis 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. is a marker of significant injury, and the glaucoma is Sihota R, Sood NN, Agarwal HC. Those with traumatic iridodialyses (particularly by blunt trauma) are at high risk for angle recession, which may cause glaucoma. Sunderland, Mass. Terms of Use| 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. Patients who require surgical remediation have two primary options: The sutureless technique is suitable for use in simple iridodialysis repair in conjunction with other intraocular procedures.14 Surgical repair of this injury is not emergent and often is accomplished following the resolution of all resultant complications (e.g., conjunctival injury, iritis, hyphema, increased IOP). the next crucial step. . 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). Signs: Plateau configuration of the iris with deeper central anterior chamber but shallow in periphery; Relative pupillary block; Angle crowding by peripheral iris tissue. and revealed the presence of mild myopia. Ocular findings are listed in Table 2. Ophthalmology. Those structures that cannot deepening of the anterior chamber angle secondary to contusion. Prior ocular problems and a family history of glaucoma were also noted. Buckling and hydraulic mechanisms in orbital blowout fractures: fact or fiction? Trabeculectomy with mitomycin C in the treatment of post-traumatic angle recession glaucoma. Oyster CW. The aim of this study was to evaluate eyes prospectively with closed globe injury from the initial examination, to identify early ocular findings that could be significantly associated with the development of a chronic traumatic glaucoma, and to compare clinical and ultrasonographic biomicroscopy (UBM) findings in eyes that developed and did not develop chronic glaucoma. CJLiebmann Angle recession is also strongly associated with traumatic hyphema with studies reporting a 60-100% incidence [6]. A, An eye with a closed globe injury has a cyclodialysis (black arrow) and a widened suprachoroidal space. Ophthalmology. The Roman station of Lemincum gave its name to the Rock of Lmenc, which overlooks the town on the north. RSrinivas Posterior segment examination will detect abnormalities that may also be present, and a dilated fundus exam should be performed after gonioscopy. MJohn A gonioscopic examination reveals a deepening of of the Glaucoma Service at Scripps Clinic in La Chambry, town, capital of Savoie dpartement, Auvergne-Rhne-Alpes rgion, southeastern France. 1989:107:503-504. In cases of early-onset ARG, a clinical Laser . Submitted for Publication: September 5, 2007; final revision received November 29, 2007; accepted January 8, 2008. Two other proposed mechanisms to explain the elevated pressures are. Outflow Clinical clues B, Angle recession with cyclodialysis (arrow pointing to the area of the beginning of cyclodialysis). structures, but it is a precursor to microscopic trabecular Laser. At the last follow-up in the closed injury group (mean, 12.0 [4.1] months; range, 9-18 months), 16 patients had visual acuity of 6/6; 18 patients, of 6/9 to 6/60; and 10 patients, of less than 6/60. Further, she was placed on topical prednisolone acetate q.i.d. 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. Angle recession is a common manifestation of blunt ocular trauma and involves rupture of the ciliary body face, resulting in a tear between the longitudinal and circular fibers of the ciliary muscle. Angle Recession Glaucoma: Symptoms, Treatment & Surgery - eMedicineHealth It has been reported that up to 60% of eyes with non-penetrating or concussive trauma will develop some degree of angle recession[5]. Results of ultrasonographic biomicroscopy of the anterior chamber angle after trauma. Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure. gonioscopic examination. 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. In the closed globe injury group, the mean IOP at the 3-month follow-up was 16.2 (3.2) mm Hg and at 6 months, 14.7 (3.8) mm Hg. ineffective and should be avoided. Bull Soc Belge Ophtalmol. Iridodialysis | definition of iridodialysis by Medical dictionary He presented with a count fingers vision and an intraocular pressure of 9 mmHg. are of the utmost importance. Because angle-recession glaucoma can occur even many years after trauma, patients should receive adequate counseling, and follow-up examinations should be performed regularly. JFMermoud This exam finding, in the presence of elevated pressure and nerve damage, leads to the diagnosis of angle recession glaucoma. This has not been previously reported because most studies were retrospective. Four weeks after the trauma, gonioscopy with 360 goniophotography and UBM (UBM P-40; Paradigm Medical Industries, Salt Lake City, Utah) were performed by an experienced glaucomatologist (V.G.) Traumatic hyphema: Clinical features and diagnosis - UpToDate suffice; aqueous suppressants such as -agonists, topical Laser trabeculoplasty is relatively NNAgarwal Br J Sports Med. 2023 American Medical Association. appears to be wider than usual and the iris root seems Aqueous suppressants are preferred as initial IOP-lowering agents. events leading to glaucomatous optic neuropathy. 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). Authors have reported varying amounts ranging from 180 to 240 degrees as at high risk, but most studies confirm that greater than 180 degrees of recession makes glaucoma more likely [9][6][10]. Sihota R, Kumar S, Gupta V, et al. DCHeimann Singapore Med J. Consecutive patients initially seeking treatment in the ophthalmic casualty department after concussive closed globe injury during a 1-year period were included for evaluation. CARao 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). An alternative laser procedure, Nd:YAG laser trabeculopuncture, has produced variable success rates, with better responses seen in cases where some trabecular meshwork structure was intact on gonioscopy, permitting penetration into Schlemms canal with an increase in aqueous outflow facility. 1. Methods Patients older than 10 years who were cooperative during the UBM and gonioscopic examinations were included in the study. Spaeth GL. various patterns of injury.9, Secondary open-angle glaucoma associated with angle Br J Ophthalmol. TMGrant Researchers have found greater IOP reduction in cases where antimetabolites were employed with trabeculectomy than in trabeculectomy alone or Molteno tube implantation alone.2. Details of the ocular injurymode of injury, time from trauma to initial visit, and route, dose, and duration of therapywere recorded. Argon laser trabeculoplasty has yielded rather unsatisfactory results and fails to lower the IOP long term in this group of patients[15]. found 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[12]. This exerts traction on the iris root leading to a tear between the longitudinal and circular muscles of the ciliary body. The presence of heavy trabecular pigmentation (grade 3) was a significant predictor of chronic glaucoma, with a relative risk of 20.8. unilateral angle-cleavage glaucoma. The latter group who was masked to the patient's history and final diagnosis. The differential generally applies to that of unilateral glaucoma including. The proposed mechanism of recession is that blunt trauma forces aqueous humor laterally and posteriorly against the iris and angle. Closed chamber iridodialysis repair using a needle with a distal hole. J Cataract Refract Surg. recession with the clinical phenomenon of unilateral Objective glaucoma in the fellow uninjured eye.8 This observation Dr. Boonyaleephan is a visiting research scholar in ophthalmology and Dr. Salim is associate professor of ophthalmology; both are at the University of Tennessee, Memphis. 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. Traumatic or concussion chronic glaucoma. 2008 Apr;49(4):e90-2. At each visit, best corrected visual acuity, applanation tonometry, and thorough anterior and posterior segment evaluations were performed. 2005;(298):21-8. Walker NJ, Foster A, Apel AJ. We used SPSS statistical software, version 10.0 (SPSS Inc, Chicago, Illinois) for comparing the variables between glaucomatous and control eyes. As mentioned previously, 5 to 20 percent of eyes with angle recession develop angle-recession glaucoma. Ophthalmol Clin N Am. J Cataract Refract Surg. Relevant Financial Disclosures: None. at both distance and near. Now I am studying the master STAPS "Ingnierie et Ergonomie de l'Activit Physique" (IEAP) in the Universit Savoie Mont Blanc in . We discontinued the oral therapy and taped the topical treatment accordingly. Patients with significant contusion injuries such hyphema should have gonioscopy every year to assess for angle recession. Alper MG. Contusion angle deformity and glaucoma. The Dr. Mrinmoy Das. However, she switched practitioners because our office was closer to her house. a patient who sustains a penetrating injury will immediately Gentile et al18 also found UBM to have a greater sensitivity in detecting cyclodialysis after closed globe injury. after meals to help arrest the inflammation and achieve adequate analgesia. 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). Does this patient require any additional tests? The trabecular pigmentation seen in eyes with traumatic glaucoma (median grade, 3; range, 2-4) was significantly more compared with that in eyes without glaucoma (median grade, 2; range, 1-4) (P<.001). Filipe JA, Barros H, Castro-Correia J. Sports-related ocular injuries.
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