Epidemiology and outcomes of hyphema: a single tertiary centre experience of 180 cases

Abstract

To characterize the epidemiology and outcomes of hyphema. Methods: Retrospective case series. Medical records from patients with traumatic and spontaneous hyphema seen at the Wilmer Eye Institute, Johns Hopkins, from 2011 through 2017 were evaluated. Aetiology, demographics, clinical characteristics, complications, management and outcomes were ascertained. Multivariable logistic regression was used to identify factors associated with elevated intraocular pressure (IOP), rebleeding and poor outcome (final visual acuity ≤ 20/40) in traumatic hyphema. A safe frequency of follow-up was retrospectively determined. Results: Traumatic hyphema (n = 152) was more common in males (78%) and adults (55%), with sports/recreational activities being the most frequent cause (40%). Elevated IOP was the most common complication (39%). Rebleeding occurred in seven patients (5%) and was more likely with a higher IOP on presentation (OR:1.1; p = 0.004). Thirty-seven patients (24%) had a poor outcome, mostly due to traumatic sequelae such as cataract (32%) or posterior segment involvement (30%). A poor outcome was more likely with worse presenting visual acuity (OR: 9.1; p = 0.001), rebleeding (OR: 37.5; p = 0.035) and age > 60 years (OR: 16.0; p = 0.041). Spontaneous hyphema (n = 28) did not have a gender predominance and was more common in adults > 60 years (71%). The most common cause was iris neovascularization (61%). Complications and visual outcomes were worse compared with traumatic hyphema. Conclusions: Traumatic hyphema continues to be common in young males engaging in sports, necessitating increased awareness for preventive eyewear. Older age and rebleeding can lead to poor outcomes. Elevated IOP at presentation predisposes to rebleeding and warrants frequent follow-up. Otherwise, routine follow-up at days 1, 3, 5, 7 and 14 is sufficient for uncomplicated cases.

Predictors of Long-term Ophthalmic Complications after Closed Globe Injuries Using the IRIS® Registry (Intelligent Research in Sight)

“… 6 , 43 Nearly 40% of patients who present with traumatic hyphema can develop ocular hypertension, and follow-up schedules and risk stratification tools have been proposed to help identify patients who might require intervention for elevated intraocular pressure. 17 , 45 However, our data suggest that in addition to regular intraocular pressure monitoring and gonioscopy to assess for angle recession, patients who present with hyphema after blunt ocular trauma should also be counseled regarding their increased risk of retinal break and RD both early (0–60 days after trauma) and late (60 days after trauma) and undergo dilated fundus examination for posterior segment monitoring.…”

Risk Factors for Hyphema Following Kahook Dual Blade Goniotomy Combined With Phacoemulsification

“…This trend is consistent with various studies on traumatic hyphemas, in which a male preponderance has consistently been reported. 30,31 Interestingly, Iftikhar et al 32 showed that traumatic hyphemas were significantly more likely in males (119/158, 78%), whereas spontaneous hyphemas secondary to neovascularization of the iris had no sex predominance (15/28, 54%). Male sex has also been associated with a higher rate of postoperative complications in orthopedic surgery that requires postsurgical activity limitation.…”

Creation of a New Explosive Injury Equipment to Induce a Rabbit Animal Model of Closed Globe Blast Injury via Gas Shock

“…Self-absorption of hyphema was relied on less amount of blood and healthy anterior chamber angle. Persistent blood accumulated indicated damage or obstruction to the anterior chamber angle, which could result in the elevation of IOP followed by optic nerve damage, especially in the older patients ( 27 ). Moreover, retrospective study about traumatic hyphema from combat ocular injury recorded in Walter Reed Ocular Trauma Database (WRTOD) demonstrated that traumatic hyphema were highly associated with the traumatic cataract formation, retinal detachment, angle recession, and final VA of <20/200 ( 28 ).…”