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Sickle cell trait as a risk factor for secondary hemorrhage in children with traumatic hyphema
1Department of Ophthalmology, University of Tennessee, Memphis 38163, USA.
Insights
Sickle cell trait significantly increases the risk of secondary hemorrhage, high intraocular pressure, and vision loss in children with traumatic hyphemas. This finding is crucial for managing pediatric eye injuries.
Area of Science:
- Ophthalmology
- Pediatric Traumatology
- Genetics
Background:
- Traumatic hyphemas in children can lead to serious visual complications.
- Identifying risk factors is crucial for effective management and prevention of poor outcomes.
Purpose of the Study:
- To identify risk factors for secondary hemorrhage and poor visual outcomes in pediatric patients with traumatic hyphemas.
- To investigate the role of sickle cell trait in the development of complications.
Main Methods:
- Retrospective review of 99 eyes from 97 children under 18 with traumatic hyphema.
- Analysis of patient records for factors including race, age, sickle cell trait status, hyphema size, intraocular pressure, and medications.
- Follow-up data on visual acuity and complications.
Main Results:
- Secondary hemorrhage occurred in 9% of all cases.
- African-American children had a 14% rate of secondary hemorrhage, but this was primarily linked to sickle cell trait.
- Children with sickle cell trait experienced significantly higher rates of secondary hemorrhage (64%), increased intraocular pressure, and permanent visual impairment compared to those without the trait.
Conclusions:
- Sickle cell trait is a major risk factor for secondary hemorrhage in pediatric traumatic hyphemas.
- The presence of sickle cell trait is associated with increased intraocular pressure and permanent visual impairment.
- Screening for sickle cell trait is vital in managing children with traumatic hyphemas.
Purpose:
To determine risk factors for secondary hemorrhage and poor visual outcome in children with traumatic hyphemas.
Methods:
We reviewed 99 eyes of 97 children younger than 18 years who had been hospitalized for hyphema within 48 hours of blunt eye trauma. Inpatient records were examined for race, age, sickle cell trait status, size of hyphema and intraocular pressure at admission, secondary hemorrhage (rebleed of hyphema), and medications while hospitalized. Fifty-five eyes of 53 children had at least 1 month of follow-up or attained best-corrected visual acuity of 20/50 or better at their last outpatient visit.
Results:
Among 99 eyes of 97 children with traumatic hyphema, secondary hemorrhage occurred in nine eyes (9%). Among 72 eyes of 70 African-American children, secondary hemorrhage occurred in nine eyes (14%), whereas in 27 eyes of 27 white children, there were no secondary hemorrhages. However, when the 14 eyes of 13 sickle cell trait-positive children were excluded from the African-American group, the 57 eyes of sickle cell trait-negative African-American and white children did not have any secondary hemorrhages. The sickle cell trait-positive group had secondary hemorrhages in nine of 14 eyes (64%), significantly (P < .005) different from the 0% rate in the 57 eyes of African-American sickle cell trait-negative and white children. The sickle cell trait-positive group also had higher intraocular pressure and permanent visual impairment.
Conclusion:
Sickle cell trait is a significant risk factor for secondary hemorrhage, increased intraocular pressure, and permanent visual impairment in children who have traumatic hyphemas following blunt trauma.