Üçüncü Basamak Sağlık Merkezinde Oküler Travmaya Bağlı Göz İçi Basıncı Yüksekliklerinin Tanı ve Tedavi Sürecinin Değerlendirilmesi: 1990-2018 yılları arası 28 yıllık analiz

Abstract

AIM: To evaluate the etiological and demographic characteristics and treatment processes of patients with trauma-induced elevated intraocular pressure (IOP).
 MATHERIAL AND METHOD: We retrospectively analysed 191 patients with elevated IOP after trauma between 1990 and 2018. Demographic characteristics, type of trauma, cause of glaucoma, lens status, visual acuity, IOP, other ocular findings, medical and/or surgical treatments and follow-up periods were recorded.
 RESULTS: A total of 148 (77.5%) males and 43 (22.5%) females with a mean age of 29.68±19.47 years were analysed. Mean follow-up period was 158±23.73 months. The type of trauma was blunt in 171 patients (89.5%) and open in 20 patients (10.5%). The mean interval between trauma and IOP elevation was 78 days (3 days-5 years). Glaucoma was due to angle regression in 89 (46.6%), hyphema in 78 (40.8%), lens-related in 24 (12.6%) and other causes in 3 (1.54%) patients. Lens damage, lens-related IOP elevation and need for surgical intervention were more common after open injuries. 72% of the patients were able to achieve appropriate IOP with observation and medical treatment alone without surgery. Trabeculectomy was the most preferred effective surgical method in both trauma groups. 
 CONCLUSION: The development of glaucoma after ocular trauma is an essential factor affecting visual prognosis. Early diagnosis and treatment might be challenging in proportion to the severity of ocular involvement. However, not all IOP elevations may cause glaucomatous damage, transient IOP elevations could be monitored without medication. In our study, the frequency of posttraumatic IOP elevation was higher in men and young people. This might be related to more trauma exposure in the indicated population. Blunt traumas cause IOP elevation more frequently. In contrast, the need for glaucoma surgery is more frequent after open injuries. Angle recession is the most common cause of posttraumatic glaucuma. Therefore, angle assessment is necessary in all possible cases. The status of the lens after trauma will affect the prognosis and choice of surgery. Regular follow-up is crucial for the detection of secondary glaucoma since IOP elevation may develop in the late post-traumatic period. 
 
 Keywords: Ocular trauma, blunt trauma, angle recession glaucoma, traumatic glaucoma