Damage to the Blood-Aqueous Barrier in Ocular Blunt Trauma and Its Association with Intraocular Pressure Elevation

Abstract

Background: The aim of this study is to provide a quantitative evaluation of the blood-aqueous barrier (BAB) in patients with ocular blunt trauma and evaluate its association with intraocular pressure (IOP) elevation. Methods: This is a prospective case-control study, and the following 3 groups were included: elevated IOP (45 patients with an elevated IOP secondary to ocular blunt trauma), normal IOP (27 patients with a normal IOP after ocular blunt trauma), and healthy controls. The main outcome measures were IOP and BAB function evaluated using a laser flare-cell meter (LFCM). Results: Patients had significantly higher flare intensities and cell counts than the normal controls (both p < 0.001), and the elevated-IOP group displayed even higher LFCM readings than the normal-IOP group. Aqueous flare and cell readings were positively correlated with IOP (r = 0.529 and 0.590, respectively, p < 0.001). LFCM readings in the elevated-IOP group were still significantly high even on postraumatic day 120 following anti-inflammatory treatment. Conclusion: BAB dysfunction occurred following ocular blunt trauma. Eyes with an elevated IOP displayed a more seriously disturbed BAB and a longer recovery course. Examination with a LFCM provides insight into the pathophysiology of IOP elevation and assists in making decisions concerning anti-inflammatory treatment during follow-up.

Die Blut-Augen-Schranken und ihre Störungen: Anatomie, Physiologie, Pathologie

“…Nach stumpfem Bulbustrauma kommt es zu einem Zusammenbruch der BKS mit erhöhten Flare-Werten und Zellinfiltraten im Kammerwasser, die mit der Höhe des Augeninnendrucks korrelieren [23]. Dabei zeigten hypertensive Augen unter antientzündlicher Therapie eine stärkere und länger anhaltende BKS-Störung (bis 120 Tage) als normotensive Augen, die bereits nach 30 Tagen eine Normalisierung der BKS-Funktion zeigten.…”

“…After blunt bulbar trauma, there is a breakdown of the BAB, with increased flare values and cell infiltrates in the aqueous humor; this correlates to the level of intraocular pressure 23 . In this context, hypertensive eyes under anti-inflammatory therapy showed a more severe and longer lasting BAB disturbance (up to 120 days) than normotensive eyes, which showed a normalization of BAB function after just 30 days.…”