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Predictors and Outcomes of Ocular Hypertension After Open-globe Injury

Turalba, Angela V. MD*,†,‡; Shah, Ankoor S. MD, PhD*,†,§; Andreoli, Michael T. MD; Andreoli, Christopher M. MD*,†,¶; Rhee, Douglas J. MD*,†,§

doi: 10.1097/IJG.0b013e318265bb4a
Original Studies

Purpose: Evaluate predictors and outcomes of ocular hypertension after open-globe injury.

Patients and Methods: This is a retrospective, case-control study reviewing records of consecutive patients with open-globe injuries treated at Massachusetts Eye and Ear Infirmary between February 1999 and January 2007. Of 658 patients treated, 382 had at least 2 months of follow-up and sufficient data to be included. Main outcome measures are visual acuity, intraocular pressure (IOP), and type of glaucoma intervention employed.

Results: Sixty-five (17%) patients developed ocular hypertension defined as IOP≥22 mm Hg at >1 visit or requiring treatment. Increased age (P<0.001), hyphema (0.025), lens injury (P<0.0001), and zone II injury (P=0.0254) are risk factors for developing ocular hypertension after open-globe injury. Forty-eight (74%) patients with ocular hypertension were treated medically, 8 (12%) underwent filtering or glaucoma drainage device surgery, 5 (8%) had IOP normalization with observation, while 4 (6%) required anterior chamber washout with no other glaucoma surgery. Patients with ocular hypertension had an average maximum IOP=33.4 mm Hg at a median follow-up of 21 days, with most patients maintaining normal IOP at all follow-up time points. Visual acuity improved over time with median acuity of hand motions preoperatively, and 20/60 at 12 and 36 months.

Conclusions: Ocular hypertension is a significant complication after open-globe injury that sometimes requires surgical intervention. Predictive factors can alert physicians to monitor for elevated IOP in the first month after trauma. Most patients with traumatic ocular hypertension had improved visual acuity and IOP normalization over time.

*Department of Ophthalmology, Massachusetts Eye and Ear Infirmary

Department of Ophthalmology, Harvard Medical School

Department of Ophthalmology, VA Boston Healthcare System

§Department of Ophthalmology, Children’s Hospital Boston

Boston University School of Medicine

Department of Ophthalmology, Harvard Vanguard Medical Associates, Boston, MA

Disclosure: The authors declare no conflict of interest.

Reprints: Douglas J. Rhee, MD, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA 02114 (e-mail: dougrhee@aol.com).

Received November 14, 2011

Accepted May 29, 2012

© 2014 by Lippincott Williams & Wilkins.