Eyeworld

SUMMER 2026 | EYEWORLD | 73 G Relevant disclosures Charria: None Kim: None Contact Charria: doc.charria@gmail.com Kim: wonkim74@hotmail.com can't perform gonioscopy in the early stages due to the injury or surgery, the angle needs to be assessed eventually. Dr. Charria also said she finds UBM helpful for seeing the lens and overall architecture of the anterior chamber. Dr. Kim said if you see angle recession on gonioscopy, it's an important finding and clue for glaucoma arising years to decades later. "People with angle recession after a traumatic event should be evaluated once a year for the rest of their life. The evaluation would include all the usual things like IOP measurement, visual field testing, optic nerve head evaluation clinically and with OCT," he said. Once you have a confirmed case of trau- matic glaucoma, Dr. Charria said some of these cases won't respond to medications or SLT, making a surgical approach the most effective management option. Depending on the state of nerve damage, you could consider starting on medication, but surgery is usually needed. MIGS in these cases, Dr. Charria said, is controversial, being most effective for mild to moderate traumatic glaucoma and due to pos- sible damage within the trabecular meshwork after trauma. Whether you choose to do a tube shunt or trabeculectomy depends on the state of the conjunctiva after trauma and the IOP level. "You can also use ECP; that's a very good approach, depending on if you don't have a very good con- junctiva or sclera," Dr. Charria said. "It would lower the IOP, and you don't need the tissue to be healthy. All that you need is for the globe to be closed." Dr. Kim said IOP-lowering medications can be effective in some cases, such as those caused by hyphema. Although if IOP is danger- ously high due to hyphema, the blood should be washed out in the operating room. Dr. Kim went on, "for ghost cell glaucoma, a pars plana vitrectomy to remove the vitreous hemorrhage may be necessary. "Sometimes the IOP elevations related to trauma are too great to be managed with medications alone and could warrant glauco- ma filtration surgery," Dr. Kim said. "The most commonly utilized in this setting are glaucoma drainage implants (aqueous shunts or tube shunts). This is because surgeries like XEN 45 [AbbVie] or trabeculectomy are at high risk for failure because traumatized eyes are often inflamed and especially eyes with penetrating injuries are often scarred, making filtration surgery more likely to fail. MIGS surgeries and AlloFlo Uveo [Iantrek] cyclodialysis-type surgeries are options to be considered, but tube shunts are probably the main surgery that most surgeons will use." Dr. Charria reemphasized that traumatic glaucoma is a late onset disease. The acute problem with the eye might be solved in the immediate aftermath of trauma, but patients need to be well educated about their need for follow-up. "If you're not a glaucoma specialist but you know the risk factors in trauma for developing traumatic glaucoma, you can suspect that it's going to happen eventually, and you should refer the patient to a glaucoma specialist," Dr. Charria said. DIGITAL Constance Okeke, MD, EyeWorld Glaucoma Editorial Board member, shared how she thinks digital advances are accelerating across the specialty: "I think one of the most meaningful developments will be the use of AI and big data to support earlier recognition of progression and treatment opportunities in glaucoma. The goal is not to replace clinical judgment but to help physicians see patterns faster and make more timely, individualized decisions. "I'm also excited by the evolution of digital surgical education, particularly simulation, video-based learning, and AI-assisted feedback. These tools can help surgeons refine technique, recognize subtle intraoperative decision points, and make high-quality surgical education more scalable."

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