Surgery Successful in Most Cases of Trauma-Linked Angle Closure

Penetrating canaloplasty significantly reduced intraocular pressure (IOP) and yielded a high success rate without postoperative bleb-related complications in patients with traumatic angle recession glaucoma, according to research published in the British Journal of Ophthalmology.

To evaluate the clinical outcomes of penetrating canaloplasty in traumatic angle recession glaucoma at 1 year, the researchers conducted a prospective interventional case series. Consecutive patients with medically uncontrolled traumatic angle recession glaucoma were recruited to the study between August 2015 and September 2020.

Patients had a history of blunt trauma with angle recession on gonioscopy and ultrasound biomicroscopy and glaucoma, defined as an IOP higher than 21 mm Hg and a glaucomatous optic nerve. Patients were excluded if they had history of another type of trauma, other secondary glaucoma, severe cardiovascular or other systemic disease, and inability to attend the follow-up visits. 

At postoperative follow-up examinations conducted at 1, 3, 6 and 12 months, the researchers evaluated IOP, number of glaucoma medications, and procedure-related complications. Surgical success was defined as an IOP 21 mm Hg or lower without (complete) or with (qualified) use of antiglaucoma medications.

A total of 45 consecutive patients (45 eyes) were included in the study. Most (40/45; 88.9%) eyes had successful circumferential catheterization of the canal. The remaining 5 eyes (11.1%) required conversion to trabeculectomy. 

Patients who underwent penetrating canaloplasty had a mean age of 42±13 years. Most of the patients were men (82%) and 18% were women. The median time from injury to development of glaucoma and glaucoma surgery was 2.0 months (range, 0.03–396.0) and 6.1 months (range, 0.13–396.0), respectively.

The researchers reported complete success in 18 of 40 (45.0%) patients at 1 month, in 32 of 40 (80.0%) of patients at 3 months, in 35 of 40 eyes (87.5%) of patient at 6 months, and in 34 of 38 (89.5%) patient at 12 months. The most common postoperative complications were hyphema (18/40; 45.0%) and transient IOP elevation (≥30 mm Hg; 9/40; 22.5%).

In patients whose penetrating canaloplasty was deemed to be a complete success, the mean IOP and mean number of anti-glaucoma medications decreased from 37.8±12.3 mm Hg and 3.3±1.2 preoperatively to 18.5±6.4 mm Hg and 1.2±1.4 medications at 1 month, 14.9±4.6 mm Hg and 0.1±0.5 medications at 3 months, 15.7±5.4 mm Hg and 0.1±0.4 medications at 6 months, and 14.8±3.6 mm Hg and 0.1±0.5 medications at 12 months postoperatively (P <.05 for all comparisons). 

Limitations of the study included the relatively short follow-up duration, lack of a clinical comparator group (such as  penetrating canaloplasty with trabeculectomy or glaucoma valve implantation), and inability to cannulate the entire canal in 5 cases.

Reference

Cheng H, Ye W, Zhang S, et al. Clinical outcomes of penetrating canaloplasty in patients with traumatic angle recession glaucoma: a prospective interventional case series Br J Ophthalmol. Published online March 22, 2022. doi:10.1136/bjophthalmol-2021-320659