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Natalie Rose Miller, Grant Justin, Daniel Brooks, Denise Ryan, Marcus Colyer; Open versus closed hyphema: lessons learned in Operations Iraqi Freedom and Enduring Freedom. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2294.
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Whether injury type (open vs. closed) predicts outcomes in patients with traumatic hyphema has not been reviewed. We performed a retrospective study to understand the complications of traumatic hyphema. Specifically, we tested the hypothesis that patients with open traumatic hyphema, when compared to patients with closed traumatic hyphema, have higher risk of glaucoma, cataract formation, retinal detachment, angle recession, low ocular trauma score (OTS), and poor final visual acuity.
The Walter Reed Ocular Trauma Database (WROTD) is a record of ocular injuries from Operations Iraqi Freedom and Enduring Freedom from 2001-2011. Inclusion criteria were United States military healthcare beneficiaries at least 18 years of age evacuated from the combat zone with combat-related hyphema. Fisher's Exact Test was performed to identify complications of traumatic hyphema versus no hyphema. Logistic regression was used to assess outcome measures of glaucoma, cataracts, retinal detachment, angle recession, OTS, and final visual acuity in patients with open and closed traumatic hyphemas.
168 of 890 (18.88%) eyes in the WROTD had a traumatic hyphema. Closed injuries were noted in 64 (38.09%) eyes and open injuries in 104 (61.91%) eyes. Patients with traumatic hyphema were more likely than patients without hyphema to have cataract formation (odds ratio (OR) 6.22, 95% confidence interval (CI) 4.24-9.15, p<0.001), retinal detachment (OR 4.23, CI 2.80-6.38, p<0.001), angle recession (OR 8.06, CI 2.93-24.29, p<0.001), OTS 1 or 2 (OR 3.32, CI 2.19-4.79, p<0.001), and final visual acuity of less than 20/200 (OR 3.73, CI 2.56-5.44, p<0.001). No significant difference was noted for glaucoma (OR 1.48, CI 0.34-5.07, p=0.51). Open traumatic hyphema is further predictive of the following complications when compared to closed traumatic hyphema: cataract formation (OR 7.40, CI 2.93-18.70, p<0.001), retinal detachment (OR 6.11, CI 2.13-17.50, p<0.001), OTS 1 or 2 (OR 6.84, CI 2.64-17.71, p<0.001), and final visual acuity less than 20/200 (OR 6.10, CI 2.41-15.44, p<0.001). No significant difference between open and closed hyphema was found for glaucoma (OR 0.61, CI 0.05-8.20, p=0.96) and angle recession (OR 0.25, CI 0.05-1.23, p=0.11).
Open hyphema is associated with cataract development, retinal detachment, and poor final visual acuity and follow-up to monitor for these complications is critical.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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