<p>Clinical Characteristics and Outcomes of Hyphema in Patients with Sickle Cell Trait: 10-Year Experience at the Wilmer Eye Institute</p>

Abstract

Purpose: To report the clinical characteristics, complications, and outcomes of hyphema in patients with sickle cell trait (SCT). Design: Retrospective case series. Methods: Medical records of SCT patients (confirmed by hemoglobin electrophoresis) presenting with hyphema at the Wilmer Eye Institute over 10 years (January 2008 through December 2017) were reviewed in detail. Data were collected regarding etiology, demographics, clinical course and management. Main outcome measures included intraocular pressure (IOP) and visual acuity (VA). Results: A total of 14 black patients (males: 57%; median age: 20 years) were included in the study with a median follow-up of 4 months (range: 1 week to 6 years). Ten patients had traumatic hyphema with a mean presenting VA of approximately 1.10 logMAR (Snellen equivalent=20/250) and a mean presenting IOP of 40 mmHg. Nine of them required medical intervention to lower IOP, and six of them ultimately required surgical intervention, primarily in the form of anterior chamber paracentesis and/or washout. The mean time to achieve IOP control was 3 days, and the mean final VA was approximately 0.10 logMAR (Snellen Equivalent=20/25). Four patients had non-traumatic hyphema with a mean presenting VA of approximately 1.8 logMAR (Snellen equivalent=20/1260) and a mean presenting IOP of 31 mmHg. Three of them required medical intervention to lower IOP, and two of them ultimately required surgical intervention. Overall, seven patients underwent anterior chamber washout, six needed an anterior chamber paracentesis to lower the IOP, two required tube shunt placement procedures and one patient underwent a trabeculectomy. The mean time to achieve IOP control was 5 days, and the mean final VA was approximately 0.80 logMAR (Snellen equivalent=20/125). Conclusion: Patients with SCT are likely to develop elevated IOP in the setting of hyphema, with a majority requiring one or more surgical interventions to achieve IOP control.

Traumatic Hyphema: Diagnostic and Management Considerations

“…Of special concern is the presence of sickle cell hemoglobinopathy, as sickled erythrocytes are especially predisposed to mechanical obstruction of the trabecular meshwork, which can lead to clinically significant blockage of aqueous outflow even in settings of limited hemorrhage. 17,18 As sickle cell disease (SCD) affects 1 in 365 black American births, black patients should be closely screened for personal or family history of SCD or SCT. 19 Visual acuity, intraocular pressure (IOP), pupillary response, assessment for relative afferent pupillary defect, measurement of layered hyphema height, and extraocular movements should be recorded before any pharmacologic manipulation.…”

“…A careful medical history should be taken at the initial presentation, with special consideration of any current anticoagulation medications or history of blood dyscrasia. Of special concern is the presence of sickle cell hemoglobinopathy, as sickled erythrocytes are especially predisposed to mechanical obstruction of the trabecular meshwork, which can lead to clinically significant blockage of aqueous outflow even in settings of limited hemorrhage 17,18 . As sickle cell disease (SCD) affects 1 in 365 black American births, black patients should be closely screened for personal or family history of SCD or SCT 19 .…”