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Medical interventions for traumatic hyphema.

Almutez Gharaibeh1, Howard I Savage, Roberta W Scherer

  • 1Department of Special Surgery-Ophthalmology, Faculty of Medicine, The University of Jordan, P.O. Box 13046, Amman, Jordan.

The Cochrane Database of Systematic Reviews
|December 5, 2013
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Summary
This summary is machine-generated.

This review found no medical interventions significantly improved visual acuity in traumatic hyphema cases. Antifibrinolytic agents like tranexamic acid may reduce rebleeding, but evidence for other treatments remains limited.

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Area of Science:

  • Ophthalmology
  • Trauma Care
  • Evidence-Based Medicine

Background:

  • Traumatic hyphema, or blood in the anterior eye chamber, can cause vision loss, especially with associated injuries or rebleeding.
  • Sickle cell trait/disease increases susceptibility to elevated intraocular pressure following hyphema.
  • Complications like corneal staining and glaucoma can lead to permanent vision impairment.

Purpose of the Study:

  • To evaluate the effectiveness of diverse medical interventions for managing traumatic hyphema.
  • To synthesize evidence from randomized and quasi-randomized trials on traumatic hyphema treatments.

Main Methods:

  • Comprehensive literature search of multiple databases (CENTRAL, MEDLINE, EMBASE, etc.) up to August 2013.
  • Inclusion of 20 randomized and 7 quasi-randomized trials involving 2643 participants.
  • Meta-analysis using a fixed-effect model to compare interventions like antifibrinolytics, corticosteroids, and non-drug therapies.

Main Results:

  • No intervention demonstrated a significant impact on visual acuity at any time point post-trauma.
  • Antifibrinolytic agents (aminocaproic acid, tranexamic acid) showed potential in reducing secondary hemorrhage rates.
  • Aminocaproic acid use was linked to longer hyphema resolution times and increased adverse events like nausea and vomiting.

Conclusions:

  • While antifibrinolytics may decrease rebleeding, no intervention significantly improves visual acuity in traumatic hyphema.
  • Treatment decisions for corticosteroids, cycloplegics, or non-drug therapies should be individualized due to limited supporting evidence.
  • Further research is needed to assess the combined effects of various interventions for traumatic hyphema management.