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Trabecular Pigmentation, Widened Angle Recess, and Higher Baseline Intraocular Pressure

Ramanjit Sihota, MD, FRCS; Sunil Kumar, MD; Viney Gupta, MD; Tanuj Dada, MD; Seema Kashyap, MD; Rajpal Insan, MD; Geetha Srinivasan, MS

Arch Ophthalmol. 2008;126(7):921-926.

Objective  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.

Methods  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.

Results  The median grade of trabecular pigmentation on gonioscopy in eyes with traumatic glaucoma was 3 compared with 2 in eyes without glaucoma (P = .001). On UBM findings, 18 eyes with closed globe injury without glaucoma showed evidence of cyclodialysis, compared with 7 eyes with glaucoma (P = .001). The relative risk of developing traumatic glaucoma was also significantly higher with hyphema, elevated baseline IOP, angle recession of more than 180°, lens displacement, and wider angles on UBM.

Conclusions  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. On UBM findings, a wider angle and the absence of cyclodialysis were significant predictors for the subsequent development of traumatic glaucoma.

Author Affiliation: Glaucoma Research Facility and Clinical Services (Drs Sihota, Kumar, Gupta, Dada, Insan, and Srinivasan) and Department of Ocular Pathology (Dr Kashyap), Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.