Post-traumatic angle-recession glaucoma is difficult to manage and surgical intervention is often required

The Science behind the Tip

Anterior chamber angle recession is the commonest physical sign of previous blunt trauma to the eye. Raised intraocular pressure (IOP) occurs secondary to trabecular damage rather than as a consequence of angle recession.

Medical treatment is unsuccessful because of poor compliance and surgery is often required. Laser trabeculoplasty is ineffective in this form of glaucoma. The presence of angle recession is a risk factor for failure of glaucoma filtration surgery, independent of age and race (1). The best results are achieved by undertaking a trabeculectomy with Mitomycin C 0.02%, applied at the time of surgery (2,3). If the conjunctiva is scarred or if the eye is aphakic or if the first surgical procedure fails to control the IOP, then a Baerveldt tube (350mm) or double-plate Molteno implant should be inserted (2,4).

Contributor: John Salmon, Oxford

References

1. Mermoud A, Salmon JF, Straker C, Murray AD. Post-traumatic angle recession glaucoma: a risk factor for bleb failure after trabeculectomy. Br J Ophthalmol. 1993;77:631-42.

2. Mermoud A, Salmon JF, Barron A, Straker C, Murray AD. Surgical management of post-traumatic angle recession glaucoma. Ophthalmology. 1993;100:634-42.

3. Manners T, Salmon JF, Barron A, Willies C, Murray AD. Trabeculectomy with mitomycin C in the treatment of post-traumatic angle recession glaucoma. Br J Ophthalmol. 2001;85:159-63.

4. Fuller JR, Bevin TH, Molteno AC. Long-term follow-up of traumatic glaucoma treated with Molteno implants. Ophthalmology. 2001;108:1796-800.

Tip Reviewer: Roger Hitchings
Tip Editors: Ann Hoste, John Salmon and John Thygesen