English

Abstract

AIMS: To study the demographic profile, clinical picture, treatment modalities and long term follow up of patients suffering from glaucoma developing after blunt trauma. MATERIALS AND METHODS: This was a prospective study over one year in which 75 eyes, newly diagnosed or referred with post traumatic glaucoma to M & J Institute of Ophthalmology were studied. All cases underwent thorough eye examination. Treatment was individualized and instituted. RESULTS: Patients ranged from 1 - 70 years with 32 patients (42.66%) below 30 years of age. 61 patients (81.33%) were males. 66.65% were students, laborers or housewives, with laborers topping the charts in vulnerability. In 46 cases (61.33%), left eye was affected, while in 29 pts. (38.66%) right eye was affected. In 54.66% of cases, trauma was caused by stone, wooden stick or ball. Others included fist, firecracker, iron rod, handle, belt.16% patients presented with IOP in the normal range, 38 (50.66%) patients had IOP in the range of 21-30 mm Hg, whereas 16 (21.33%) patients had IOP more than 40 mm Hg. Within 1 week of instituting treatment, 41 (54.66%) had IOP ≤ 20 mm Hg and only 3 patients had IOP more than 30 mm Hg. However, 70 (93.33%) patients had IOP ≤ 20 mm Hg by the end of 6 months and all the patients were in this range after 6 months. On slit lamp examination, corneal edema, traumatic mydriasis and sphincter tears were seen in 32 patients each. 12 patients had hyphema and 19 patients had lens dislocated either into vitreous or into the anterior chamber. Iridodialysis was seen in 5 patients. Other findings included cataract, posterior synechiae, subluxation of lens and tobacco dusting. 57 (76%) patients had vision less than 6/60, however after an interval of more than 6 months, 28 (37%) patients had vision less than 3/60. The number of patients having vision ≥ 6/12 rose from 5 at initial presentation to 15 in follow-up more than 6 months. Disc changes could be assessed by ophthalmoscopy in 37 (49.33%) patients at presentation. Of these, 21 (56.75%) patients had a cup-disc ratio of less than 0.5 whereas remaining 12 had a cup- disc ratio of more than or equal to 0.5. 5 patients demonstrated unhealthy neuroretinal rim, nasalized blood vessels, lamellar dot sign, deep cup. 12 had other fundus abnormalities like macular edema (5), vitreous hemorrhage (4), retinal detachment (2), vitritis (1), pre retinal membrane (1). No significant change was found in fundus examination on follow-up. As compared to the initial findings, fundus could be visualized in 62 (82.66%) subjects in follow-up. Gonioscopy could be done only in 38 patients. 26 (68.42%) had open angles and 5 patients had closed angles. 17 (44.73%) had angle recession, and 4 patients of these 17 had angle recession ≥ 180°. Other findings included iridodialysis (2 patients), cyclodialysis (1 patient), blood clots in the angle, heavy pigmentation of trabecular meshwork, convex iris and haptic of PCIOL lodged in the angle. UBM could be performed in 71 patients. It detected angle recession in 23 patients, lens subluxation or dislocation in 20 patients, hyphema in 6 patients, iridodialysis in 4 patients. UBM could also detect cyclodialysis, PAS, corneal edema, vitreous in anterior chamber, ciliary body cyst, intumescent/ cataractous lens, anterior rotation of the iris. 16 (21.33%) patients responded to a single drug regimen, 12 patients required