Angle recession and secondary glaucoma.

Abstract

In a previous article (Mooney, I972), the incidence and extent of angle tears was reported in a series of 53 cases of traumatic hyphaema examined within 3 years of the date of injury, and it was suggested that those cases with angle tears involving I8o° or more of the anterior chamber angle should have annual tonometry in order to detect the development of glaucoma in the injured eye at as early a stage as possible. The purpose of this paper is to report the findings in a series of cases examined between I I and I4 years after hyphaema due to non-perforating injury. The late development of glaucoma after traumatic hyphaema has been described by several authors. D'Ombrain (1944) drew attention to the association of ocular trauma and chronic glaucoma and described four patients with chronic unilateral glaucoma who had suffered ocular or periorbital injury i8, i6, 20, and 4 years previously. D'Ombrain substantiated his observations with further cases described in articles published in 1945, I946, and I949. He suggested that the glaucoma may be due to a process of fibrosis or cuticular proliferation in the region of the trabecular meshwork as described by Reese (I944). Wolff and Zimmerman (I962) described the early and late histopathological changes of angle recession in a series of eyes enucleated after ocular contusion and confirmed D'Ombrain's theory of the underlying cause. In early cases they noted lacerations into the face of the ciliary body with damage to the ciliary muscle. Those lacerations that passed between the circular and longitudinal muscles of the ciliary body resulted in posterior displacement of the former along with the iris root and pars plicata. They also noted disruption of the trabecular meshwork. In late cases they noted atrophy of the circular muscle fibres that had been separated from the longitudinal fibres and advanced degenerative changes of the trabecular meshwork consisting of atrophy, fibrosis, and hyalinization ofthe trabeculae and obliteration ofthe intertrabecular spaces and Schlemm's canal. In many cases there was a newly formed hyaline membrane covering the inner surface of the trabeculae continuous with Descemet's membrane and often extending into the recessed angle covering the longitudinal muscle. D'Ombrain made no comment about the gonioscopic findings in his cases, but Alper (i963) described the gonioscopic changes in a selected series of 27 non-perforating eye injuries; he noted deepening of the anterior chamber, widening of the ciliary body band and posterior displacement ofthe iris root. Fourteen of his 27 cases had chronic uniocular glaucoma in the injured eye. Pettit and Keates (I963) described eight cases of angle recession after blunt ocular trauma, one of which had chronic uniocular glaucoma 8 years after trauma. Blanton (i964) found I30 cases of angle recession in a series of I82 cases of traumatic hyphaema; four of these patients had chronic uniocular glaucoma diagnosed more than IO years after the injury and all four had angle recession involving more than 1800 of the anterior chamber angle.