Factors associated with the poor final visual outcome after traumatic hyphema

Area of Science:

• Ophthalmology
• Trauma Surgery

Background:

• Nonperforating traumatic hyphema can lead to significant visual impairment.
• Identifying factors predicting poor visual outcomes is crucial for patient management.

Purpose of the Study:

• To determine clinical factors associated with worse final visual outcomes in nonperforating traumatic hyphema.
• To compare patients with poor visual outcomes to those with better outcomes.

Main Methods:

• Retrospective case-control study comparing 18 patients with visual acuity of 0.1 or worse to 166 patients with visual acuity of 0.15 or better.
• Analysis of clinical characteristics, including anterior and posterior segment injuries, initial visual acuity, and age.

Main Results:

• Posterior segment injuries (macular edema, retinal hemorrhage, epiretinal membrane, choroidal rupture) were significant predictors of poor visual outcome (P < 0.01).
• Anterior segment injuries (corneal blood staining, traumatic mydriasis, iridodialysis, cataract, lens subluxation) also predicted poor outcomes, often with concurrent posterior segment injuries.
• Initial visual acuity ≤ 0.1, glaucoma, vitreous hemorrhage, and eyelid laceration were associated with poor outcomes (P < 0.05).
• Larger initial hyphema and older age (≥ 16 years) trended towards poorer visual acuity.
• Rebleeding did not significantly impact visual prognosis.

Conclusions:

• Posterior segment injuries are directly related to poor visual outcomes in nonperforating traumatic hyphema.
• Anterior segment injuries are also predictive, particularly when co-occurring with posterior segment damage.
• Management strategies should prioritize addressing posterior segment trauma to improve visual prognosis.