Traumatic hyphema in children: risk factors for complications.

OBJECTIVE: To identify risk factors associated with higher rates of ocular complications in children with traumatic hyphema. METHODS: Consecutive inpatient records from July 1990 through December 1997 were retrospectively reviewed for all children (aged < or = 18 years) who were admitted to the Wilmer Ophthalmological Institute, Baltimore, Md, within 48 hours of a closed-globe injury leading to hyphema. Data obtained included age, sex, race, sickle cell status, initial and final visual acuities, hyphema size and intraocular pressure at presentation, the occurrence of a secondary hemorrhage, subsequent intraocular pressure elevations, and therapeutic interventions. RESULTS: Forty children fulfilled the inclusion criteria: 20 African American, 1 Asian American, and 19 white. Five of the 20 African American children had sickle cell trait, and 1 had sickle cell anemia. The rate of secondary hemorrhage was statistically higher in the African American population (P =.05), but no statistical difference existed between the rate of secondary hemorrhage in patients with and without sickle cell hemoglobinopathy. Sickle cell hemoglobinopathy was associated with a higher intraocular pressure at presentation (P =.03) and during inpatient follow-up (P =.02). CONCLUSIONS: In the setting of traumatic hyphema, African American children appear to be at greater risk for developing a secondary hemorrhage. In our patients, sickle cell hemoglobinopathy increased the risk of intraocular pressure elevation, but did not seem to increase the risk of rebleeding beyond that associated with race. Larger studies are needed to validate these observations.

Sickle cell trait as a risk factor for secondary hemorrhage in children with traumatic hyphema.

PURPOSE: To determine risk factors for secondary hemorrhage and poor visual outcome in children with traumatic hyphemas. METHODS: We reviewed 99 eyes of 97 children younger than 18 years who had been hospitalized for hyphema within 48 hours of blunt eye trauma. Inpatient records were examined for race, age, sickle cell trait status, size of hyphema and intraocular pressure at admission, secondary hemorrhage (rebleed of hyphema), and medications while hospitalized. Fifty-five eyes of 53 children had at least 1 month of follow-up or attained best-corrected visual acuity of 20/50 or better at their last outpatient visit. RESULTS: Among 99 eyes of 97 children with traumatic hyphema, secondary hemorrhage occurred in nine eyes (9%). Among 72 eyes of 70 African-American children, secondary hemorrhage occurred in nine eyes (14%), whereas in 27 eyes of 27 white children, there were no secondary hemorrhages. However, when the 14 eyes of 13 sickle cell trait-positive children were excluded from the African-American group, the 57 eyes of sickle cell trait-negative African-American and white children did not have any secondary hemorrhages. The sickle cell trait-positive group had secondary hemorrhages in nine of 14 eyes (64%), significantly (P < .005) different from the 0% rate in the 57 eyes of African-American sickle cell trait-negative and white children. The sickle cell trait-positive group also had higher intraocular pressure and permanent visual impairment. CONCLUSION: Sickle cell trait is a significant risk factor for secondary hemorrhage, increased intraocular pressure, and permanent visual impairment in children who have traumatic hyphemas following blunt trauma.

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.

The effect of age and ethnic background on the natural rebleed rate in untreated traumatic hyphema in children.

Controlling the natural tendency to rebleed in this condition is important because the serious vision threatening complications usually follow rebleeds. In evaluating treatments, it has been difficult to determine the natural rebleed rate. Recent reports on traumatic hyphema suggest that the natural rebleed rate in this condition may be higher in blacks and young children than in Caucasians and older children and adults. The records of 38 patients who were admitted to a children's hospital and who were the untreated control group in a previous study on systemic steroid treatment for traumatic hyphema, were reviewed to determine their ethnic background and age. The data was examined to see if these characteristics were related to the rebleed rate. The overall rebleed rate in this untreated group was 32% (12 out of 38). For specific ethnic groups, the rebleed rate was: Caucasians, including presumed Hispanics--32% (10 out of 31); Caucasians, not including presumed Hispanics--33% (8 out of 24); presumed Hispanics--29% (2 out of 7). There was no statistically significant (P greater than .95) difference in rebleed rates. With regard to age, the rebleeding rate was 54% (6 out of 11) for children under six years of age, and 22% (6 out of 27) for those over six years of age. This was a statistically significant difference (P less than .05). Ethnicity, therefore, in this group of untreated patients did not affect the natural rebleed rate. Younger age, under six years, is associated with a higher natural rebleed rate in traumatic hyphema, and these children should be most carefully treated.