Glaucoma, Angle Recession Follow-up

  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Apr 29, 2010
 

Further Outpatient Care

  • As in other types of glaucoma, follow-up depends on the degree of IOP control and the risk of progressive loss of the visual field.
  • Patients with an early increase in IOP after blunt trauma should be reexamined every 4-6 weeks during the first year to monitor their condition.
    • Some early cases are self-limited, but patients should still be observed after their condition appears to resolve.
    • Other early cases represent a severe form of the disease that may be refractory to standard medical treatment; such cases warrant more frequent follow-up.
  • In cases of angle recession of greater than 180° that initially have no evidence of glaucoma, late-onset glaucoma can potentially occur, even many years after the injury. Annual examinations should be performed for an indefinite period.
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Inpatient & Outpatient Medications

  • See Medication.
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Deterrence/Prevention

  • The incidence of angle-recession glaucoma can be reduced by preventing the underlying trauma.
  • Data indicate that most pediatric and adult eye injuries (eg, sports-related accidents) are preventable.
  • Public education on the use of eye, face, or head protection during high-risk activities may lower the incidence of ocular injuries.
  • Public safety standards to reduce rates of eye injury can be achieved by enacting legislative policies such as seatbelt or helmet laws.
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Complications

  • Nonglaucomatous comorbidity in eyes with angle recession increases the risk of vision loss. Traumatic insults to the cornea, iris, lens, vitreous, retina, or optic nerve may contribute to vision-threatening sequelae.
  • Traumatic cataract often accompanies angle recession.
    • Gonioscopy should always be performed when a patient with a unilateral cataract is evaluated, even when his or her history is negative for trauma.
    • After surgical management, the risk of complications is higher with a traumatic cataract than with a senile cataract.
  • Intraoperative complications include the following:
    • Zonular dialysis
    • Vitreous loss
    • Intraocular hemorrhage
    • Inadequate posterior intraocular lens (IOL) support: Zonular injury is a common finding in such cases. When zonular defects are small, placement of the IOL into the capsular bag usually can be achieved without further complication. Placement of an anterior-chamber IOL is not preferred in eyes with even minimal angle recession, and it is fully contraindicated when the angle is recessed more than 180°.
  • Postoperative complications
    • IOP elevation
    • Inflammation
    • IOL malposition
    • Pupil capture
    • Intraocular hemorrhage
    • Glare
    • Monocular diplopia: Symptoms may result from iris abnormalities.
  • Cataract extraction in eyes with known angle-recession deformities should be approached with caution.
  • The most common posterior-segment complications after blunt trauma include macular lesions and peripheral retinal tears.
    • Posttraumatic entities involving the macula include the following:
      • Macular cysts
      • Macular holes
      • Hyperplastic-atrophic pigment epitheliopathy
      • Choroidal rupture: This is another possible finding in traumatized eyes and sometimes leads to secondary neovascular degeneration or disciform scarring.
    • Traumatic abnormalities of the peripheral retina include the following:
      • Atrophic holes
      • Horseshoe tears
      • Operculated tears
      • Retinal dialysis
      • Retinal detachment
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Prognosis

  • No formal data indicate the long-term visual outcomes of eyes with chronic angle-recession glaucoma. Eyes that develop early-onset angle-recession glaucoma are thought to represent a subgroup with most extensive angle injury, but the visible degree of angle recession is not correlated with the severity of glaucoma in this group.
  • Late-onset angle-recession glaucoma almost always occurs in eyes with more than 180° of angle recession, and the risk appears to increase with the extent of angle recession. Eyes with a 360° angle recession are at greatest risk.
  • As in most types of glaucoma, angle-recession glaucoma can cause progressive visual field loss and blindness.[33]
    • The risk of visual loss depends on many factors, particularly the timeliness of initial diagnosis and the course of management.
    • Response of elevated IOP to medical therapy varies, and with time, IOP control may deteriorate despite dependence on multiple medications.
    • Favorable results have been reported for surgical intervention of angle-recession glaucoma, but success rates are lower than those of other forms of glaucoma.
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Patient Education

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Contributor Information and Disclosures
Author

Brian R Sullivan, MD  Associate Professor, Department of Ophthalmology, University of Texas Southwestern Medical Center

Brian R Sullivan, MD is a member of the following medical societies: American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew I Rabinowitz, MD  Consulting Staff, Department of Ophthalmology, Barnet Dulaney Perkins Eye Center

Andrew I Rabinowitz, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Ophthalmology, and American Medical Association

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Assistant Professor of Ophthalmology, Jules Stein Eye Institute; Chief of Section of Ophthalmology Surgical Services, Department of Veterans Affairs Healthcare Center, West Los Angeles

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Martin B Wax, MD  Clinical Professor, Department of Ophthalmology, University of Texas Southwestern Medical School; Vice President, Ophthalmology Research and Development, Head, Ophthalmology Discovery Research, Alcon Labs, Inc

Martin B Wax, MD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Society for Neuroscience

Disclosure: Nothing to disclose.

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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Irregular widening of the visible ciliary body in a quadrant with angle recession.
Angle recession. Note the marked posterior displacement of the iris, with a wide ciliary body band posterior to the scleral spur.
Gonioscopic examination many years after blunt trauma in a patient with angle-recession glaucoma. Note the irregular contour of the iris, with loss of detail of angle structures. Classic findings of angle recession may become subtle or be obscured over time.
 
 
 
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