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Outpatient management of traumatic hyphemas in children
D K Coats1, A Viestenz, E A Paysse
1Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA. dcoats@bcm.tmc.edu
Insights
Outpatient management of pediatric traumatic hyphemas is safe, with a low rebleeding rate of 8.3% when topical steroids are used. Most children achieve good visual acuity, but vigilance for complications is crucial.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Trauma Care
Background:
- Traumatic hyphemas in children often require management, but outcome data for outpatient settings are scarce.
- Establishing effective and safe outpatient protocols is essential for pediatric eye care.
Purpose of the Study:
- To report outcomes of outpatient management for pediatric traumatic hyphemas.
- To evaluate the rebleeding rate and final visual acuity in children treated non-surgically.
Main Methods:
- Retrospective chart review of 25 children under 16 with grade I traumatic hyphemas.
- Outpatient management included inactivity, frequent monitoring, eye shields, and topical steroids.
Main Results:
- A rebleeding rate of 12% (3/25) was observed, with one case requiring surgery.
- Excluding a patient not on steroids, the rebleed rate decreased to 8.3% (2/24).
- All patients achieved visual acuity of 20/40 or better, except those with pre-existing ocular issues.
Conclusions:
- Outpatient management of pediatric traumatic hyphemas demonstrates acceptable outcomes, with a rebleeding rate comparable to literature.
- Further research should focus on identifying high-risk patients and optimizing compliance to enhance safety and acceptance of outpatient care.
Objective:
There are no outcome reports in the literature for outpatient management of traumatic hyphemas in children. Therefore we studied such cases at our institutions.
Design:
Retrospective chart review.
Participants:
25 children less than 16 years of age with grade I traumatic hyphemas.
Intervention:
Inactivity at home with frequent office visits to monitor progress and complications. Treatment otherwise varied but virtually all patients received protective eye shields and topical steroids.
Main Outcome Measures:
Rate of rebleeding and final visual acuity.
Results:
Three patients (12%) suffered a rebleed; one required surgery for clot evacuation. One of the three did not receive topical steroids and if he is excluded, rebleed rate is 2/24 or 8.3%. The hyphema resolved without sequelae in the other 22 patients. All patients had a final visual acuity of 20/40 or better except three patients (12%) who had concurrent vision-limiting ocular injuries and/or disease. Final visual acuity was 20/30 or better in all three patients with rebleeds.
Conclusions:
Our rebleed rate was within the broad range of rebleed rates reported in the literature. However, improved efforts to identify children at highest risk for rebleeding, to maximize compliance with treatments, and to consider systemic agents in selected cases, could further reduce the rebleed rate and increase acceptance and safety of outpatient management in pediatric traumatic hyphemas.