Clinical Observation Of Traumatic Angle Recession

Traumatic angle recession is mainly caused by ciliary body injury,leading to the angle of organic change.The main is tearing and separation occurs between the ciliary body of the circular muscle and longitudinal muscle,because circular muscle and iris are linked together,the contraction of the circular muscle will cause the posterior displacement of the iris root,but longitudinal muscles are still attached to the sclera spur,thus the angle becomes wider and deeper.Angle recession is mainly caused by ocular trauma,especially in ocular contusion,and it has larger rate in clinical case.In addition to causing angle recession,the ocular contusion can also be complicated with inflammation,corneal contusion,mydriasis,iridodialysis,cyclodialysis or detachment,hyphema,traumatic cataract,dislocation or subluxation of lens,vitreous hemorrhage,choroid contusion,contusion of retina damage,etc.At present our country has many different levels of trauma patients in the world,thus the incidence of angle recession has bigger,with more men.In the majority with monocular trauma patients,two eyes also visible injury.The age of onset is 7-50 years old,especially in children and young adults.Angle recession is a common complication of ocular contusion,which can be secondary to angle recession glaucoma.Angle recession glaucoma belongs to secondary glaucoma,which belongs to the refractory glaucoma in clinical and prognosis is poor.Angle recession glaucoma often have severe visual acuity and visual function damage and should be treated early.Because many patients did not take too much attention and close follow-up,glaucomatous optic nerve damage can not be reversed after years.In recent years,it is generally agreed that patients with angle recession glaucoma advocate medication to control intraocular pressure(IOP).If the IOP appeared poor or to avoid serious complications,operation intervention.As it can cause serious visual acuity and visual function damage,so it is very important to protect the visual function.The clinical data of 56 cases(56 eyes)with ocular blunt trauma combined with angle recession in our hospital or outpatient treatment from March 2015 to September-2016 were analyzed.Objective:Through the clinical observation of patients with traumatic angle recession,analysis and summary of treatment methods to guide the clinic.Methods:The study included 56 eyes in 56 consecutive patients with angle recession diagnosed by UBM(ultrasound biomicroscopy)who underwent treatment or outpatient treatment at the Second Hospital of Hebei Medical University in the department of ophthalmology from 2015.3-2016.9.Gonioscope tests carried out on the patient after corneal no edema,anterior chamber without hemorrhage and aqueous humor clear.All patients were also examined with slit lamp biomicroscopy,fundoscopic,IOP,color doppler ultrasound and binocular field examination.On the basis of traumatic angle recession range,the patients were divided into four groups: group A:the range of less than or equal to 90°;group B:the range of more than 90° and less than or equal to 180°;group C:the range of more than 180° and less than or equal to 270°;group D:the range of more than 270° and less than or equal to 360°.Each patient was recorded for 6 months in the IOP values respectively.If the patient had elevated IOP during the follow-up period,the patients were treated with topical or combined systemic IOP lowering therapy.Drugs were generally preferred to use reduce aqueous humor generated of anti glaucoma medications,such as ?-adrenergic receptor blockers,?2-adrenal agonists and carbonic anhydrase inhibitor drugs,etc.And recorded the time of the high IOP.The above 4 groups of patients were recorded cases of the following five situations after 6 months follow-up time: 1)in a normal IOP;2)medication control IOP normal range,withdrawal later without recurrence;3)local application of two kinds of drugs control IOP normal more than half a year;4)local application of two kinds of drugs was invalid(IOP > 21 mmHg),the application of two kinds of above drugs could controled IOP normal range for more than half a year,vision without damage;5)drugs treatment were invalid and vision had progressive damage during follow-up time,to surgical treatment.Record the number of cases in the above 5 situation.The cure rate,effective rate and no cure rate were calculated.Calculated each group the incidence of secondary glaucoma.Calculation method(five cases under different groups):conservative treatment cure rate = 2)+3)/total number of elevated IOP;conservative treatment efficiency = 2)+ 3)+ 4)/ total number of elevated IOP;conservative treatment no cure rate =5)/ total number of elevated IOP.Results:1 The inclusion criteria of 56 cases of ocular blunt injury had different extent of angle recession.The number of cases for the different groups of patients:19 cases of A group were less than or equal to 90°(33.93%),B group:5 cases of more than 90° and less than or equal to 180°(8.93%),C group:11 cases of more than 180°and less than or equal to 270 °(19.64%),D group:21 cases of more than 270°and less than or equal to 360°(37.50%).Three patients developed traumatic angle recession glaucoma.One patient was more than 180°and less than or equal to 270 °.Two patients were more than 270°and less than or equal to 360°.Angle recession patients combined with hyphema in 23 cases,iridodialysis in 10 cases,traumatic mydriasis in 7 cases,traumatic cataract in 6 cases,lens dislocation in 5 cases,vitreous hemorrhage in 6 cases,choroidal contusion 15 cases,retinal concussion or injury in 10 cases.2 The correlation test results between the extent of angle recession and secondary glaucoma.Three patients were diagnosed as traumatic angle recession glaucoma in 56 cases,1 cases of more than 180°and less than or equal to 270 °,2 cases of more than 270°and less than or equal to 360°.Three of patients with greater than 180°angle recession were elevated IOP,and no patient with less than 180° was no elevated IOP.Three cases were all above 180°.The relationship between the extent of angle recession and secondary glaucoma r=0.949,P=0.026 < 0.05.Therefore,it is considered that there was a correlation between more than 180°of angle of recession and the incidence of glaucoma.3 Fifty-three of traumatic angle recession in 56 cases were normal IOP(IOP values:15.34 ± 2.18mmHg),and three cases were diagnosed of traumatic angle recession glaucoma.One case was the range of more than 180°and less than or equal to 270 °.The onset of elevated IOP occurred in 2 months after injury.IOP was the highest value of 41 mmHg.Two of the local application of anti glaucoma drugs could control IOP to normal levels(IOP values:20.06 ±3.06mmHg),vision no defect.Two cases were the range of more than 270°and less than or equal to 360 °.The onset of elevated IOP occurred in 3 months after injury.IOP was the highest value of 24 mmHg.One of the local application of anti glaucoma drugs could control IOP to normal levels(IOP values:20.05±2.29mmHg).The other one case treated by local maximum safe dose combined with systemic anti glaucoma drugs was ineffective,and the final trabeculectomy and mitomycin C(MMC)were performed.The IOP was well controlled(IOP values:15.04±1.28mmHg).Two of the 3 cases secondary glaucoma patients were treated with local anti glaucoma drugs.The normal IOP controled for more than half a year.There was no visual field damage during the follow-up period.The cure rate and effective rate of conservative treatment were 66.67%,and the no cure rate of conservative treatment was about 33.33%.The incidence of A group and B group of secondary glaucoma was 0,and 9.09% in C group,9.52% in D group.Conclusions:1 The incidence of traumatic angle recession glaucoma is the extent of above 180°.2 Conservative treatment can be cured in 3 quadrants or 4 quadrants of traumatic angle recession glaucoma.