Aspirin and secondary bleeding after traumatic hyphema

A randomized, controlled study was conducted in 51 patients to investigate the effect of aspirin administration on traumatic hyphema. Aspirin tablets 500 mg tid were administered for seven days. Rebleeding was found in three of 23 eyes of patients who had received aspirin and in two of 28 eyes of control patients. This difference was not statistically significant (P = .405), proving that aspirin is not an important factor in rebleeding in patients with hyphema.     

An analysis of risk for secondary hemorrhage in traumatic hyphema

ObjectiveFactors such as size of hyphema, intraocular pressure, initial visual acuity, and use of steroids or antifibrinolytic drugs may be associated with the likelihood of rebleeding in traumatic hyphema. The association of the visual outcome with secondary hemorrhage has been questioned.DesignRandomized, placebo-controlled, clinical trial.ParticipantsTwo hundred and thirty-eight patients who had hyphema develop after blunt trauma.InterventionEighty patients received oral tranexamic acid, 80 patients received placebo, and 78 patients received oral prednisolone.Main outcome measuresSecondary hemorrhage and vision at the time of discharge from the hospital were measured.ResultsRebleeding occurred in 43 (18%) of the patients and was prevented significantly by oral tranexamic acid compared with the placebo (odds ratios [OR] = 0.39; 95% confidence interval [CI], 0.17, 0.89). Occurrence of secondary hemorrhage had weak associations with initial high intraocular pressure (OR = 2.7; 95% CI, 0.99, 7.3) and initial visual acuity of 6/60 or less (OR = 1.8; 95% CI, 0.9, 3.7). Secondary hemorrhage had no statistical association with age, gender, oral prednisolone, size of hyphema, and retinal damage. Visual acuity of 6/60 or less at the time of discharge was significantly associated with rebleeding (OR = 10.5; 95% CI, 3.7, 29.2), initial visual acuity of 6/60 or less (OR = 9.9; 95% CI, 2.8, 38.0), retinal damage (OR = 14.6; 95% CI, 3.8, 55.8), and male gender (OR = 6.5; 95% CI, 1.4, 31.9). Final visual acuity had no significant statistical association with age, use of oral prednisolone or tranexamic acid, and size of hyphema.ConclusionsHigh intraocular pressure and low vision at the time of first examination may be associated with increased chance of rebleeding. Retinal damage, secondary hemorrhage, male gender, and initial poor vision are associated with a worse visual outcome in patients with traumatic hyphema.     

The incidence of rebleeding in traumatic hyphema

A collaborative, retrospective study of 371 consecutive hyphema patients reveals an overall 3.5% incidence of rebleeding of without the use of antifibrinolytic agents. Numerous factors were reviewed on each patient, including age, sex, race, grade of hyphema, disposition, and the use of topical or systemic medications. Thirty percent of the patients were treated on an outpatient basis. The low incidence of rebleeding, particularly in less severe hyphemas (less than half the anterior chamber volume), does not support the routine use of systemic antifibrinolytics or corticosteroids.     

Secondary hemorrhage in traumatic hyphema

We analyzed the records of 132 patients hospitalized between July 1986 and February 1989 for management of traumatic hyphema. The incidence of secondary hemorrhage was compared between patients treated with or without systemic administration of aminocaproic acid in addition to an otherwise identical protocol. Results among patients who were examined within one day of injury disclosed a 4.8% secondary hemorrhage rate in aminocaproic acid-treated patients (three of 63 patients) compared with a 5.4% rate in the patients not treated with aminocaproic acid (three of 56 patients, P = .31). All six patients sustaining secondary hemorrhage recovered visual acuities of 20/40 or better, with five of six patients achieving 20/20 visual acuities. A separate group of 13 patients who were examined more than one day after injury were found to have a secondary hemorrhage rate of 38.5% (five of 13 patients). Macular injury, not secondary hemorrhage, was most often responsible among those patients suffering permanent visual loss. In this study of a predominantly white population, patients had a relatively low incidence of secondary hemorrhage and did not demonstrate detectable benefit from aminocaproic acid administration. Because of the recognized side effects and cost of treatment, further analysis to determine which patients will benefit from treatment with aminocaproic acid is indicated.     

Recurrent hemorrhage in traumatic hyphema.

A retrospective review of hospital records reveals that over 90% of recurrent bleeds in traumatic hyphema occur at night. It is postulated that rapid eye movement (REM) sleep, with its displays of saccadic virtuosity, is the major reason for the nocturnal prevalence of such recurrent hyphemas. Theoretical considerations suggesting a more rational therapy of traumatic hyphema are presented and clinical trials are suggested.     

挫伤性前房积血继发性青光眼的治疗

目的探讨挫伤性前房积血继发青光眼的治疗方法。方法对67眼挫伤性前房积血继发青光眼采取双眼包扎、半卧位、限制活动及止血剂、抗炎、降眼压药物应用等保守治疗。对保守治疗未愈的46眼采取手术治疗。结果67眼经保守治疗21眼（31．34％）治愈。手术治疗的46眼中32眼（69．57％）治愈，13眼（28．26％）好转，1眼（2．17％）无效。结论挫伤性前房积血继发青光眼药物治疗无效者及时采用手术治疗效果良好。     

t-PA治疗外伤性前房积血继发青光眼

目的 探讨组织型纤溶酶原激活剂（tissue plasminogen activa-tor,t-PA)治疗外伤性前房积血继发青光眼的临床效果和安全性。方法 16例（16眼）保守治疗无效的眼挫伤引起的前房积血继发青光眼患者，平均眼压43.18mmHg，于伤后5-16d前房注入t-PA10μg。结果 注药后72h16例前房积血全部吸收，48h眼压全部恢复正常，无并发症出现。结论 前房注射t-PA治疗外伤性前房积血继发青光眼是一安全，有效的方法。     

Ultrasonic decompression of malignant ocular hypertension secondary to traumatic hyphema

The prognosis of traumatic hyphemias in general is favorable, the blood being resorbed spontaneously in a short period. The case is different, however, where hemorrhage is abundant, and the condensed blood in the anterior chamber coagulates; here, the angle is often blocked with fibrin, the intraocular pressure rises considerably, accompanied always with severe pain. The arrest of aqueous circulation by the consolidated clot suppresses the process of resorption; thereafter, local and general therapeutic measures become ineffective. The state of "malignant hypertension" once established, surgical intervention becomes imperative. In this study are given the results of 10 cases of traumatic hyphemia complicated by malignant hypertension, treated by ultrasonic irradiation. The results are obviously favorable: rapid fall of ocular hypertension with prompt disappearance of subjective symptoms; revelation of signs of liquefaction and resumption of processes of resorption in 9 patients. Under continued treatment, complete resorption of the hyphemia was attained with accelerated pace. In one case, however, unrelenting hypertension persisted to the 12th day, despite the complete liquefaction of the coagulum. A phakotopic factor lying under the hyphemia was suspected. The visual recuperation was remarkable in 7 cases free from posterior segment alterations.     

Management of traumatic hyphema

Hyphema (blood in the anterior chamber) can occur after blunt or lacerating trauma, after intraocular surgery, spontaneously (e.g., in conditions such as rubeosis iridis, juvenile xanthogranuloma, iris melanoma, myotonic dystrophy, keratouveitis (e.g., herpes zoster), leukemia, hemophilia, von Willebrand disease, and in association with the use of substances that alter platelet or thrombin function (e.g., ethanol, aspirin, warfarin). The purpose of this review is to consider the management of hyphemas that occur after closed globe trauma. Complications of traumatic hyphema include increased intraocular pressure, peripheral anterior synechiae, optic atrophy, corneal bloodstaining, secondary hemorrhage, and accommodative impairment. The reported incidence of secondary anterior chamber hemorrhage, that is, rebleeding, in the setting of traumatic hyphema ranges from 0% to 38%. The risk of secondary hemorrhage may be higher in African-Americans than in whites. Secondary hemorrhage is generally thought to convey a worse visual prognosis, although the outcome may depend more directly on the size of the hyphema and the severity of associated ocular injuries. Some issues involved in managing a patient with hyphema are: use of various medications (e.g., cycloplegics, systemic or topical steroids, antifibrinolytic agents, analgesics, and antiglaucoma medications); the patient's activity level; use of a patch and shield; outpatient vs. inpatient management; and medical vs. surgical management. Special considerations obtain in managing children, patients with hemoglobin S, and patients with hemophilia. It is important to identify and treat associated ocular injuries, which often accompany traumatic hyphema. We consider each of these management issues and refer to the pertinent literature in formulating the following recommendations. We advise routine use of topical cycloplegics and corticosteroids, systemic antifibrinolytic agents or corticosteroids, and a rigid shield. We recommend activity restriction (quiet ambulation) and interdiction of non-steroidal anti-inflammatory agents. If there is no concern regarding compliance (with medication use or activity restrictions), follow-up, or increased risk for complications (e.g., history of sickle cell disease, hemophilia), outpatient management can be offered. Indications for surgical intervention include the presence of corneal blood staining or dangerously increased intraocular pressure despite maximum tolerated medical therapy, among others.     

外伤性前房积血的治疗

目的探讨外伤性前房积血的治疗。方法54例(54眼)外伤性前房积血入院后均采用双眼包扎,静卧,20%甘露醇125 mL静脉滴注,止血敏、止血芳酸及地塞米松等药物治疗;有凝血块并引起眼压升高者施行前房穿刺及尿激酶冲洗。结果54例外伤性前房积血的视力均有提高;Ⅰ级积血2~4天吸收,Ⅱ级积血6~9天吸收,Ⅲ级积血8~13天吸收。结论及时而合理用药、双眼包扎及适当静卧,可减少继发出血和并发症的发生。     

健康教育对外伤性前房积血继发青光眼患者的影响

目的:探讨对外伤性前房积血继发青光眼患者实施健康教育的方法与临床效果。方法:将259例患者根据有无实施系统的健康教育分为观察组147例,对照组112例,分析两组的满意度、复诊率、相关知识掌握率,并进行统计分析。结果:两组满意率分别为93.9%,81.2%;两组复诊率分別为86.4%,70.5%;相关知识掌握率分别为89.8%,72.3%。经统计学处理,差异有统计学意义(P<0.01)。结论:在疾病变化不同阶段,向患者发放不同的健康教育处方,可有效提高患者对自身疾病的认识和重视程度,从而提高治疗效果,提高对医护人员的满意度。患者能自觉复诊,提高了服务质量,体现医院人性化管理。同时,使护理人员自身价值得到体现。     

Outcome of traumatic hyphema.

One hundred and twenty-seven cases of traumatic hyphema are reviewed and discussed according to a definite system of grading. Grade iii hyphemas have definitely a poorer prognosis than Grade ii and Grade i hyphemas. Rebleeding occurs more frequently when there is a delay in treatment but does not appear to affect the outcome of a traumatic hyphema. Blood staining of the cornea could be avoided by an adequate treatment started immediately after the trauma, thus decreasing the percentage of blindness following a traumatic hyphema.     

Factors associated with the poor final visual outcome after traumatic hyphema

In order to determine the factors related to the worse final visual outcome following nonperforating traumatic hyphema, the clinical characteristics of 18 patients with visual outcome of 0.1 or worse were compared with those of 166 patients with visual outcome of 0.15 or better. The presence of posterior segment injuries such as macula edema, retinal hemorrhage, epiretinal membrane, and choroidal rupture were significant factors of a poor final visual outcome (P < 0.01). The presence of anterior segment injuries such as corneal blood staining, traumatic mydriasis, iridodialysis, cataract, and lens subluxation had significant predictive factors on a poor final visual outcome and the concurrent posterior segment injuries were more frequent in these patients. Initial visual acuity of 0.1 or worse, glaucoma, vitreous hemorrhage, and eyelid laceration were also significant associations of a poor final visual outcome (P < 0.05). Patients with initially larger hyphema (grade I or more vs microscopic) and older age group (16 years or more vs 15 years or less) tended to have poor final visual acuities. Rebleeding was not associated with significant deterioration in visual prognosis. We conclude that the posterior segment injuries seem to be directly related to a poor visual outcome rather than the occurrence of secondary hemorrhage.