Tranexamic acid in the treatment of pediatric traumatic hyphema.

BACKGROUND: This study was undertaken to determine whether a difference exists in treatment outcome between patients treated with tranexamic acid (TEA) plus topical steroids and those treated with topical steroids alone. METHODS: A retrospective cohort study was conducted to compare treatment results for children with traumatic hyphema treated with TEA and topical steroids versus topical steroids alone. Patients were identified from a chart review of the Children's Hospital of Eastern Ontario eye clinic and the Queen's Department of Ophthalmology emergency eye clinic for charts coded "traumatic hyphema." The primary outcomes measured included visual acuity, rebleed rate, intraocular pressure, and time to hyphema resolution. Covariates were hyphema grade, the need for medications to lower intraocular pressure, and the presence of associated ocular traumatic complications. Analysis was performed with both bivariate analysis and multivariate models. RESULTS: Two hundred and fifteen patients with traumatic hyphema were included in our study. One hundred and thirty-seven patients (63.1%) received TEA plus topical steroids, and the remaining 78 patients received topical steroids alone. There was no significant difference in rebleed rate between the TEA plus topical steroid group (1.6%) and the steroid-alone group (2.6%, p = 0.60). INTERPRETATION: Patients with traumatic hyphema treated with TEA plus topical steroids did not have a significantly lower incidence of rebleed than those treated with topical steroids alone.

Myopia and astigmatism in retinopathy of prematurity after treatment with cryotherapy or laser photocoagulation.

BACKGROUND: Visual outcome studies have shown that laser photocoagulation may result in more favourable clinical outcomes than cryotherapy in threshold retinopathy of prematurity (ROP). Comparative refractive outcome studies have shown that patients treated with laser photocoagulation have less myopia than those treated with cryotherapy. We carried out a study to determine whether a difference in visual outcome or refraction exists in patients with threshold ROP who have been treated with cryotherapy vs. laser photocoagulation. METHODS: A retrospective cohort study was conducted comparing treatment results after at least 3 years of follow-up in patients with threshold ROP treated with cryotherapy or laser photocoagulation at a tertiary care children's hospital. Visual acuity and refraction were the outcomes studied. Covariates measured were sex, gestational age and birth weight. Analysis was performed with both bivariate analysis and multivariate models. RESULTS: Seventy-one eyes of 37 patients with threshold ROP were included in the study. Thirty-seven eyes received cryotherapy, and 34 eyes received laser photocoagulation. The mean spherical equivalent refraction was significantly lower in the cryotherapy group than in the laser photocoagulation group (-9.21 dioptres vs. -1.80 dioptres, p = 0.001). Patients in the cryotherapy group were more likely than those in the laser photocoagulation group to have against-the-rule astigmatism (odds ratio 6.86, p = 0.004). Laser photocoagulation did not significantly lower the frequency of an unfavourable visual outcome (visual acuity worse than 20/200) (p = 0.09). INTERPRETATION: Eyes with threshold ROP treated with laser photocoagulation were significantly less myopic and less likely to have against-the-rule astigmatism than those treated with cryotherapy.