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H. R. Khan-Farooqi, P. Chiranand, S. L. Edelstein; Epidemiology and Outcome of Traumatic Hyphema: A Retrospective Case Series. Invest. Ophthalmol. Vis. Sci. 2010;51(13):1314.
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To report the epidemiology, morbidity, prevalence of associated blood dyscrasia, therapeutic interventions, complications and outcomes of patients with traumatic hyphema.
Retrospective case series. Exclusion criteria included ruptured globe and non-traumatic causes of hyphema.
51 patients (51 eyes) within an 8 year window period met inclusion criteria. Mean age was 23 years (range 4 to 66 years) and 88% were male. The left eye was the affected side in 53% (27/51) of patients. Positive testing for sickle cell trait or disease was noted in 12% (6/51) of patients. The most frequently associated mechanisms of injury were sporting-related in 20% (10/51), assault in 20% (10/51), BB gun in 12% (6/51), paintball gun in 8% (4/51), bottle rocket in 8% (4/51), and MVA in 8% (4/51). The most frequent hyphema-related ocular complication was ocular hypertension (IOP > 25 mmHg), occurring in 51% (26/51) of patients, of which 31% (8/26) required an anterior chamber washout. Ocular hypertension occurred in all 6 patients with sickle cell, of which 67% (4/6) required an anterior chamber washout. Re-bleeding occurred in 8% (4/51) of patients, all of whom developed ocular hypertension. Corneal blood staining occurred in 4% (2/51) of patients. Associated ocular or orbital injury occurred in 57% (29/51) of patients; including traumatic cataract in 18% (9/51), vitreous hemorrhage in 16% (8/51), orbital wall fracture in 16% (8/51), iridodialysis in 14% (7/51), subluxated lens 6% (3/51), retinal tear in 6% (3/51), retinal detachment in 2% (1/51), and retinal hemorrhage in 2% (1/51). Final visual acuity of better than 20/50 was noted in 86% (19/22, with 2/22 lost to follow up) of patients without associated ocular or orbital injury, compared with 52% (15/29, 3/29 lost to follow up) of those with associated injury. Final visual acuity was worse than 20/200 in 14% (7/51) of patients.
Traumatic hyphema predominantly affects young males and can be associated with significant morbidity. Nearly half of all cases (47%; 24/51) could theoretically have been prevented by wearing protective eyewear, as in the cases of sport, paintball/BB gun, and bottle rocket-related injuries. Ocular hypertension is a common early complication, especially affecting patients with sickle cell, with a disproportionate number of this subset of patients requiring an anterior chamber washout. Poor prognostic indicators include re-bleeding, sickle cell trait or disease, and other associated ocular or orbital injury.
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