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abnormal neuro-imaging have normal retinas. Patients with only nonskull fractures are unlikely to have retinal hemorrhages. Conclusions: In our population, evaluation for NAT should include both neuro-imaging and DFE, as DFE alone would miss a large portion of patients. Patients with isolated fractures may be considered low-risk for retinal hemorrhages.048 Intraocular pressure spike after secondary IOL implantation in aphakic glaucoma. John H. Boden, Casey Mickler, Rupal H. Trivedi, M. Edward Wilson Purpose: We compared the incidence of intraocular pressure (IOP) spike after secondary intraocular lens (IOL) implant in eyes with and without aphakic glaucoma. Methods: This is a retrospective review of pediatric secondary IOL implantation performed by a single surgeon (MEW) on 133 eyes of 85 patients. Post operative day one records were reviewed and evaluated for historical elements and examination findings that would suggest an increase in IOP, and IOP readings when applicable (IOP greater then 21 mmHg). Results: In 133 eyes, 22 eyes had the diagnosis of aphakic glaucoma at the time of secondary IOL implantation. An early postoperative acute rise in IOP was noted in 6 of 22 eyes (27.3%) diagnosed with aphakic glaucoma versus 3 of 111 eyes (2.7%) without glaucoma (p \ 0.001). Two out of the 9 eyes with IOP spikes on post operative day one were asymptomatic (IOP measured 28 and 26 mm Hg). The seven eyes that were symptomatic had an average IOP of 38mmHg (range 26-65 mmHg) Discussion: We compared the incidence of an early post operative IOP spike in patients with and without aphakic glaucoma when receiving a secondary IOL implant. Patients with aphakic glaucoma had an increased incidence of having a post-operative elevation in IOP. Conclusions: The high incidence of a symptomatic early IOP spike in patients with aphakic glaucoma warrants meticulous ophthalmic viscosurgerical device ("viscoelastics") removal at the end of surgery and consideration of the routine use of prophylactic topical and systemic glaucoma medication during the early postoperative period.