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Outpatient management of traumatic hyphema in children: prospective evaluation
Karolinne Maia Rocha1, Elisabeth Nogueira Martins, Luiz Alberto S Melo
1Department of Ophthalmology, Federal University of São Paulo, Brazil.
Insights
Outpatient management is effective for pediatric traumatic hyphema. However, severe hyphema and posterior segment injuries can negatively impact final visual acuity in children.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Trauma Care
Background:
- Traumatic hyphema is a common ocular injury in children.
- Effective management strategies are crucial for preserving visual function.
Purpose of the Study:
- To assess the clinical outcomes of pediatric patients with traumatic hyphema managed on an outpatient basis.
- To identify factors influencing visual acuity and treatment interventions.
Main Methods:
- A prospective case series involving 35 children with traumatic hyphema treated as outpatients.
- Data collected included visual acuity, slit-lamp examination, hyphema grade, intraocular pressure, and complications.
Main Results:
- Most patients (68.6%) had low-grade hyphema; 48.6% experienced elevated intraocular pressure.
- Unsatisfactory visual acuity was linked to posterior segment lesions and higher hyphema grades.
- Surgical intervention was required in 25.7% of cases, with 8.6% experiencing rebleeding.
Conclusions:
- Outpatient management is a viable approach for pediatric traumatic hyphema.
- The severity of hyphema and co-existing posterior segment injuries are critical determinants of visual outcomes.
Purpose:
To evaluate the clinical outcome of children with traumatic hyphema treated on an outpatient basis.
Methods:
A prospective cases series. Thirty-five children with traumatic hyphema were treated as outpatients for the ocular injury from February 2002 to February 2003. Data regarding initial and final visual acuity, slit-lamp biomicroscopy, hyphema size,ophthalmoscopy, intraocular pressure, rebleeding, clearance time, and medical and surgical intervention were recorded.
Results:
Thirty (85.7%) children were male, and the major cause of traumatic hyphema was domestic tools (14 cases, 40.0%). Twenty-four patients (68.6%) presented low grades of hyphema. Seventeen patients (48.6%) had intraocular pressures higher than 24 mm Hg. The most common lesions associated with traumatic hyphema were corneal injuries (16 cases, 45.7%). The median final visual acuity was 20/25. Unsatisfactory final visual acuity (worse than 20/30) was statistically associated with ocular posterior segment lesions (P = 0.009) and grade of hyphema (P = 0.004). The grade of hyphema was also related to intraocular hypertension (P = 0.018) and time for hemorrhage absorption (P < 0.001). Nine patients (25.7%) underwent surgical intervention. Rebleeding occurred in three patients (8.6%).
Conclusions:
Outpatient management is a feasible option for children with hyphema. Associated posterior ocular segment injuries and hyphema of greater magnitude were related to the worst final visual acuities.