Blunt trauma and unstable IOP

[ronen2000]

Dear Sir,

I have badly injured my eye (blunt trauma) 10 weeks ago. The hit caused a 360 angle recession, traumatic cataract (PCS) and a macular hole + a tear in the pupil...

I was hospitalized for 8 days where the IOP was raised - after 3 days -  to 40, and than dropped down by full topical drops back to normal. than, after 8 days, released home with only steroid drops.

After 4 days at home i came for an inspection with IOP 57. This was immediately treated with full topical and 2 pills, lowering the pressure to 24, after 2 hours. Than i was released home with the drops and pills. After 2 more days - another inspection. IOP is fine. Removed from pills. Left only with drops. And since than, it's been a roller coaster. 2 weeks fine (with full drops only) and than iop around 40. than again, pills, inspection after 3 days, iop fine, removed from pill and come again. This was "working" till the point where drops and one time pill, couldn't help any more so I needed also pills (uramox, 2-3 times a day) on regular basis. this was managed to lower the pressure to no lower than 22, so Dr was start to talk about a filtration surgery ("3 type of drops+pill and get iop 22, is not good...")

Than, after 2 weeks, iop drops again to around 16, and it's been for a week now, with full medication.
My cataract is planned for next week.

3 question:

1) From the day of the trauma, I took the steroids for a month, 6 times a day, and than stopped about 6 weeks ago. Could it be that the steroids still effects the iop and the roller coaster is because of that?

2) Could it be that the IOP spikes/ roller coaster is because of the trauma and not because the angle recession has started the glaucoma now? (meaning, that maybe the eye is becoming "stable" and so is the IOP?)

3) I yes, than what might be the prognosis for a future glaucoma (I'm 45 years old)?

Thank you....

[ronen2000]

Hi again,

And if the iop remains at the normal levels, do i still need to have the surgery?

What should be better to have in a traumatic angle recession glaucoma: a shunt (ie, the Express shunt) or a trab?

Thanx again!

[Ray T Oyakawa, MD]

The main reason the glaucoma is the angle recession.  Steroids may have contributed-usually it resolves with the stopping of steroids but not always.  You do have glaucoma. At this time you need a filter or shunt with cataract surgery.

Dr. O.