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Conversion to Glaucoma After Ocular Trauma in Pediatric Patients
Nur Cardakli1, Rujuta A Gore1,2, Courtney L Kraus1
1Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Insights
Pediatric glaucoma suspects with closed-globe injuries had higher rates of ocular hypertension and developed glaucoma. No open-globe injuries progressed to glaucoma, indicating a difference in outcomes based on injury type.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Glaucoma Research
Background:
- Outcomes for pediatric glaucoma suspects with ocular trauma history are largely unknown.
- This study focuses on the conversion rate to glaucoma in this specific patient group.
Purpose of the Study:
- To determine the rate of glaucoma development in pediatric patients with a history of ocular trauma.
- To compare outcomes between open-globe and closed-globe injuries in pediatric glaucoma suspects.
Main Methods:
- Retrospective case series of pediatric patients (2005-2016) with ocular trauma monitored as glaucoma suspects.
- Inclusion criteria: history of open- or closed-globe trauma.
- Data collected on injury type, treatment, and glaucoma development.
Main Results:
- 62 eyes from 62 pediatric patients were analyzed; 46.8% open-globe, 53.2% closed-globe injuries.
- Eyes with closed-globe injuries had higher rates of topical therapy for ocular hypertension (36.4% vs. 10.3%).
- Five eyes (8.1%) developed glaucoma, all with prior closed-globe injuries; 4 required glaucoma surgery. Most post-traumatic glaucoma cases (60%) had concurrent intraocular surgeries.
Conclusions:
- All pediatric glaucoma cases following trauma in this cohort resulted from closed-globe injuries.
- No cases of open-globe injury in pediatric glaucoma suspects progressed to glaucoma.
- Injury type significantly impacts glaucoma development risk in pediatric ocular trauma patients.
Background:
The outcomes of pediatric glaucoma suspects with a history of ocular trauma remains unknown; we describe the rate of conversion to glaucoma of this population of patients at a research-intensive academic center.
Methods:
We conducted a retrospective case series of pediatric patients with a history of open- or closed-globe trauma who were being monitored as pediatric glaucoma suspects at the Wilmer Eye Institute between 2005 and 2016.
Results:
A total of 62 eyes from 62 patients with a history of ocular trauma were identified with a median age at presentation of 9.7 years (7.8 years) and a median follow-up of 2.7 (5.8 years). There were 29 eyes (46.8%) with open-globe injuries and 33 eyes (53.2%) with closed-globe injuries. A higher proportion of eyes that sustained closed-globe injuries were started on topical therapy for persistent ocular hypertension than eyes that sustained open-globe injuries (36.4% versus 10.3%, X2 = 5.6976, p = 0.017). Five eyes (8.1%) developed glaucoma during the follow-up period, all of which had a history of closed-globe injury (15.2%, X2 = 4.7794, p = 0.029). Four eyes of these eyes underwent glaucoma-related surgical intervention. Most eyes (3/5, 60%) that went on to develop post-traumatic glaucoma had undergone additional and/or concurrent intraocular surgical interventions to address sequelae of ocular trauma, such as traumatic cataract and retinal detachment.
Conclusions:
All eyes that developed glaucomatous damage or underwent glaucoma-related surgical intervention in this cohort of patients with a history of ocular trauma were those that had sustained close-globe injuries. No eyes that sustained open-globe injury progressed to glaucoma.
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