Traumatic Angle Recession with Secondary Glaucoma- A Case Series Study

Purpose: To describe the patterns of outcomes and management approaches to patients diagnosed with angle recession glaucoma presenting at the Glaucoma Department, Chittagong Eye Infirmary & Training Complex, Bangladesh.

Design: A hospital-based prospective observational case series review.

Participants: 25 patients who were diagnosed with angle recession glaucoma over a 1-year period from November 1st 2009 to October 31st 2011.

Method: Patient particulars, history and mechanism of trauma were recorded. Ophthalmic examination details (including gonioscopy, intraocular pressure and fundoscopy) and management given were documented. Similar relevant details were recorded for three follow-up periods, on all patients, extending over a total period of 9 months.

Results: 25 patients with angle recession glaucoma were included in the study. Twenty-two of the patients were male. The mean age of patients was 34.9 ± 20.84 years (Range: 9–72 yrs). All patients had an angle cleavage of more than 180 degrees, with 68% having a recession of 360 degrees. 56% had a history of hyphaema. In 88% of patients, the intra-ocular pressure (IOP) was controlled and kept at a stable level (<21mmHg) over follow-up. Of these, 91% were controlled by conservative treatment (topical anti-glaucoma drugs or observation) and 9% was controlled after cataract surgery. Patients with uncontrolled IOP (12%) were advised for filtration surgery. The mean IOP at time of diagnosis was 29.8 ± 9.7mmHg (Range: 14 – 50mmHg). The mean IOP at last follow-up was 18.4 ± 8.4mmHg (Range: 10 – 50mmHg). Visual Acuity (VA) for 23 patients (92%) either remained stable or improved.

Conclusion: Angle recession glaucoma can cause further loss of vision in ocular trauma patients who may already have compromised vision due to injury. Control of IOP and preservation of presenting VA was seen in most cases with conservative management with topical medications and sustained follow-up. Patients sustaining blunt ocular trauma, especially those associated with hyphaema, should be advised for future follow up and have gonioscopic evaluation of the angle.