Risk Factors and Clinical Manifestations of Ocular Hypertension after Primary Repair of Open Globe Injury

Yeon Soo Kang; Sang Woo Park

doi:10.3341/jkos.2015.56.8.1242

Journal List > J Korean Ophthalmol Soc > v.56(8) > 1010056

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kang and Park: Risk Factors and Clinical Manifestations of Ocular Hypertension after Primary Repair of Open Globe Injury

Original Article

J Korean Ophthalmol Soc 2015;56(8):1242-1247.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.8.1242

Risk Factors and Clinical Manifestations of Ocular Hypertension after Primary Repair of Open Globe Injury

Yeon Soo Kang, M.D., Sang Woo Park, M.D., PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwangju, Korea

Address reprint requests to Sang Woo Park, MD, PhD Department of Ophthalmology, Chonnam National University Hospital, #42 Jebong-ro, Dong-gu, Gwangju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642 E-mail: exo70@naver.com

∗ This study was presented as a poster at the 112th Annual Meeting of the Korean Ophthalmological Society 2014.

Received 16 January 201523 April 2015 Accepted 1 July 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To investigate the risk factors and clinical manifestations of ocular hypertension (HTN) after repair of open globe injury (OGI).

Methods

In a retrospective study of 284 patients who underwent primary repair of open globe injury at the day of trauma, best corrected visual acuity (BCVA) at the time of trauma and 6 months postoperatively, length of laceration, location of laceration and mean intraocular pressure (IOP) at 1 month after primary repair were analyzed. Presence of iris injury, lens injury, intraocular for-eign body (IOFB) and vitreous hemorrhage (VH) were also analyzed. Ocular hypertension was defined as elevation of IOP great-er than or equal to 21 mm Hg over 3 measurements.

Results

Fourteen (4.93%) of 284 patients had ocular hypertension. BCVA (log MAR) at the time of trauma in the ocular HTN group was significantly worse than in the normal IOP group (2.43 ± 1.04 and 1.76 ± 1.30, respectively, p = 0.033). In the multi-variate analysis, ocular HTN increased significantly with IOFB ( p = 0.038; odds ratio [OR], 3.584; 95% confidence interval [CI], 1.075-11.941) and VH ( p = 0.028; OR, 3.971; 95% CI, 1.157-13.624). BCVA increased significantly after repair in both groups and mean IOP was well controlled after medical therapy (9 eyes) or surgical treatment (5 eyes) in the ocular HTN group (28.1 ±4.7 and 15.8 ± 3.8, respectively, p < 0.01).

Conclusions

Ocular HTN increased significantly with IOFB and VH at the time of trauma after repair of OGI and can be effec-tively treated by medication or surgical approach.

Keywords: Intraocular pressure, Ocular hypertension, Open globe injury

References

1. Kuhn F, Morris R, Witherspoon CD. . A standardized classi-fication of ocular trauma. Ophthalmology. 1996; 103:240–3.

2. Négrel AD, Thylefors B. The global impact of eye injuries. Ophthalmic Epidemiol. 1998; 5:143–69.

3. Osman EA, Al-Fawaz N, Al-Otaibi AG. . Glaucoma after open globe injury at a tertiary care university hospital in Central Saudi Arabia. Cumulative incidence and risk factors. Saudi Med J. 2013; 34:374–8.

4. De Leon-Ortega JE, Girkin CA. Ocular trauma-related glaucoma. Ophthalmol Clin North Am. 2002; 15:215–23.

5. Milder E, Davis K. Ocular trauma and glaucoma. Int Ophthalmol Clin. 2008; 48:47–64.

6. Turalba AV, Shah AS, Andreoli MT. . Predictors and outcomes of ocular hypertension after open-globe injury. J Glaucoma. 2014; 23:5–10.

7. Girkin CA, McGwin G Jr, Long C. . Glaucoma after ocular contusion: a cohort study of the United States Eye Injury Registry. J Glaucoma. 2005; 14:470–3.

8. Sihota R, Kumar S, Gupta V. . Early predictors of traumatic glaucoma after closed globe injury: trabecular pigmentation, wid-ened angle recess, and higher baseline intraocular pressure. Arch Ophthalmol. 2008; 126:921–6.

9. Shiuey Y, Lucarelli MJ. Traumatic hyphema: outcomes of out-patient management. Ophthalmology. 1998; 105:851–5.

10. Girkin CA, McGwin G Jr, Morris R. . Glaucoma following penetrating ocular trauma: a cohort study of the United States Eye Injury Registry. Am J Ophthalmol. 2005; 139:100–5.

11. Acar U, Yı ldı z EH, Ergintürk Acar D. . Posttraumatic intra-ocular pressure elevation and associated factors in patients with zone I open globe injuries. Ulus Travma Acil Cerrahi Derg. 2013; 19:115–8.

12. Kuhn F, Maisiak R, Mann L. . The Ocular Trauma Score (OTS). Ophthalmol Clin North Am. 2002; 15:163–5.

13. Schmidt GW, Broman AT, Hindman HB. . Vision survival after open globe injury predicted by classification and regression tree analysis. Ophthalmology. 2008; 115:202–9.

14. Yu Wai Man C, Steel D. Visual outcome after open globe injury: a comparison of two prognostic models-the Ocular Trauma Score and the Classification and Regression Tree. Eye (Lond). 2010; 24:84–9.

15. Jung HH, Park JW, Park SW. Comparison of portable tonometers and Goldmann applanation tonometer for intraocular pressure measurement. J Korean Ophthalmol Soc. 2014; 55:102–9.

Table 1.

Baseline characteristics of patients

	No ocular HTN (n = 270)	Ocular HTN (n = 14)	p-value
Mean age (years)^∗	51.6 ± 16.2	54.9 ± 12.4	0.466
Sex (male/female)^†	237/33	13/1	0.482
Mean initial BCVA (log MAR)^∗	1.76 ± 1.30	2.43 ± 1.04	0.033
Mean last BCVA (log MAR)^∗	1.10 ± 1.29	1.34 ± 1.26	0.497
Mean laceration length (mm)^∗	4.51 ± 3.59	4.57 ± 2.38	0.951
Mean IOP (mm Hg)^∗	17.6 ± 5.3	28.1 ± 4.7	<0.001
Location^†
Cornea (n, %)	164 (60.7)	6 (43.0)
Sclera (n, %)	68 (25.2)	4 (28.5)	0.264
Corneosclera (n, %)	38 (14.1)	4 (28.5)

Values are presented as mean ± SD unless otherwise indicated. HTN = hypertension; BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; IOP = intraocular pressure.

^∗ Mann-Whitney test;

^† Chi-square test, Fisher exact test.

Table 2.

Univariate and multivariate analysis for risk factors of ocular HTN

	No ocular HTN	Ocular HTN	Univariate analysis		Multivariate analysis
	No ocular HTN	Ocular HTN	OR (95% CI)	p-value	OR (95% CI)	p-value
Mean age	51.6 ± 16.2	54.9 ± 12.4	0.999 (0.963-1.037)	0.969
Sex (male/female)	237/33	13/1	3.250 (0.352-29.964)	0.298
Mean initial BCVA (log	MAR) 1.76 ± 1.30	2.43 ± 1.04	1.750 (0.953-2.979)	0.093
Iris injury	149 (55.2%)	9 (64.3%)	1.462 (0.477-4.477)	0.504
Lens injury	112 (41.5%)	10 (71.4%)	3.527 (1.079-11.530)	0.037	2.480 (0.691-8.897)	0.163
IOFB	50 (18.5%)	7 (50.0%)	4.400 (1.477-13.109)	0.008	3.584 (1.075-11.941)	0.038
VH	94 (34.8%)	10 (71.4%)	4.681 (1.429-15.329)	0.011	3.971 (1.157-13.624)	0.028

Values are presented as mean ± SD unless otherwise indicated. Logistic regression test.

HTN = hypertension; OR = odds ratio; CI = confidence interval; BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; IOFB = intraocular foreign body; VH = vitreous hemorrhage.

Table 3.

Change of BCVA (log MAR)

	BCVA (pre operation)	BCVA (post operation)	p-value
No ocular HTN	1.76 ± 1.30	1.10 ± 1.29	<0.01
Ocular HTN	2.43 ± 1.04	1.34 ± 1.26	0.018

Values are presented as mean ± SD unless otherwise indicated. Wilcoxon singled rank test. BCVA = best corrected visual acuity; log MAR = logarithm of the minimum angle of resolution; HTN = hypertension.

Table 4.

Change of IOP (mm Hg)

	IOP (pre treatment)	IOP (post treatment)	p-value
Ocular HTN	28.1 ± 4.7	15.8 ± 3.8	<0.01

Values are presented as mean ± SD unless otherwise indicated. Wilcoxon singled rank test. IOP = intraocular pressure; HTN = hypertension.

TOOLS

Similar articles