The choice and efficacy of the drugs for traumatic intraocular hypertension and glaucoma

Purpose: To evaluate the clinical efficacy of antihypertensive drugs in the treatment of posttraumatic hypertension and glaucoma.

Methods: The retrospective study was carried out in Regional Clinical Hospital N 3 in Chelyabinsk. Posttraumatic eye hypertension was detected in 76 patients: 65 (85.5%) men and 11 (14.5%) women, the average age was 49±12.7 years. Blunt trauma of the eye globe occurred in 55 (72.3%) patients, open globe injuries were registered in 21 (27.7%). Рatients were prescribed with eye drops: timolol 0.5%, brin-zolamide 1%, fixed combination: brinzolamide 1% + timolol 0.5% and systemic acetazolamide 250 mg orally 2-3 times daily for the course of 3-5 days. The changes of intraocular pressure (IOP) and visual functions were evaluated in assessing the effectiveness of treatment.

Results: Baseline IOP level was 25-43 mm Hg. Medical reduction of IOP was achieved in 56% of patients, mostly after the administration of a brinzolamide 1% + timolol 0.5% fixed combination, or when combined with acetazolamide orally (68%).

The IOP decreased in 6.07% patients after brinzolamide 1% administration, in 7.67% patients after a fixed combination of brinzolamide 1% with thymolol 0.5% and 16.78% patients after brinzolamide in combination with beta-blockers and systemic carbonic anhydrase inhibitors. In case of insufficient effectiveness of conservative therapy - 39 (51%) patients underwent various surgical procedures.

Conclusion: IOP increase after an eye globe injury may have a transient nature and may be controlled by conservative therapy or its combination with various types of eye surgery. The most statistically significant decrease of IOP in post-traumatic hypertension and glaucoma can be achieved using a brinzolamide 1% + timolol 0.5% fixed combination simultaneously with systemic carbonic anhydrase inhibitors.

1. Bojikian K.D., Stein A.L., Slabaugh M.A., Chen P.P. Incidence and risk factors for traumatic intraocular pressure elevation and traumatic glaucoma after open-globe injury. Eye. 2015; 29:1579-1584. doi: 10.1038/eye.2015.173.

2. Gundorova R.A., Neroev V.V., Kashnikov V.V. Travmy glaz [Eye Injuries]. Moscow: GEOTAR-Media; 2009: 553. (In Russ.).

3. Ganekal S., Dorairaj S. Angle recession glaucoma following blunt trauma. J Vis Sci. 2015; 1(2):28-37.

4. Sihota R., Kumar S., Gupta V. Early predictors of traumatic glaucoma after closed globe injury. Arch Ophthalmol. 2008; 126(7):921-926. doi: 10.1001/archopht.126.7.921.

5. Acar U., Yildiz E.H., Erginturk Acar D., Altiparmak U.E. et al. Posttraumatic intraocular pressure elevation and associated factors in patients with zone I open globe injuries. Turkish J Trauma and Emergency Surgery. 2013; 19(2):115-118.

6. Bai H., Yao L., Wang D. Causes and treatments of traumatic secondary glaucoma. Eur J Ophthalmol. 2009; 19(2):201-206.