Angle Recession Glaucoma Follow-up

Updated: May 31, 2017
  • Author: Brian R Sullivan, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Follow-up

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

See the list below:

  • 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 of cataract surgery in traumatized eyes include the following:
    • Zonular dialysis
    • Vitreous loss
    • Intraocular hemorrhage
    • Suboptimal or 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.

Angle recession of more than 180° is a risk factor for glaucoma. [2] 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. [43] 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

Patients with angle recessions of greater than 180°, without evidence of glaucoma, should be advised of the need for lifelong follow-up care.

For patient education resources, see the Glaucoma Center, as well as Angle Recession Glaucoma, Understanding Glaucoma Medications, and Glaucoma FAQs.

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