Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, widened angle recess, and higher baseline intraocular pressure.

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 degrees, 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 degrees 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.