An analysis of risk for secondary hemorrhage in traumatic hyphema |
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| Affiliation: | 1. Department of Ophthalmology, Shiraz University of Medical Sciences, Shiraz, Iran;2. Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran;1. Ophthalmology, Montefiore Medical Center, Albert Einstein College of Medicine, 135 East 71st Street, New York, NY 10021, USA;2. Private Practice, New York, NY, USA;1. Ophthalmology Department, Saint Victor Center, University Hospital of Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France;2. Anesthesiology Department, University Hospital of Amiens, 354, boulevard de Beauvillé, 80000 Amiens, France;1. Oculo-Facial Plastic Surgery, London, UK;2. Centre for London Facial Cosmetic & Plastic Surgery, London, UK;3. Prasad Cosmetic Surgery, New York, NY, USA;4. Division of Oculofacial Plastic & Reconstructive Surgery, Winthrop University Hospital, State University of New York College of Medicine, NY, USA;1. Department of Ophthalmology, College of Medicine, Chungnam National University, Deajeon, South Korea;2. Department of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia;1. Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran;2. Biotechnology Research Center, International Campus, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran;3. Abortion Research Center, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran;4. Industrial Biotechnology Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran;5. Research and Clinical Center for Infertility, Yazd Reproductive Sciences Institute, Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran;6. Novel Diagnostics and Therapeutics Research Group, Institute of Biotechnology, Ferdowsi University of Mashhad, Mashhad, Iran;1. Private Practice, Cosmetic and Facial Surgery of East Alabama, 2971 Corporate Park drive, Opelika, AL 36801, USA;2. UAB Oral and Maxillofacial Surgery, 1919 7th Avenue South, Birmingham, AL 35233, USA |
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| Abstract: | 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. |
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