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At least 19 recordsLinked to original sources
PubMed1979

Sickled erythrocytes, hyphema, and secondary glaucoma: I. The diagnosis and treatment of sickled erythrocytes in human hyphemas.

Four patients with sickle cell hemoglobinopathies (one SC, three AS) and hyphemas were found to have more erythrocytes sickled in their anterior chambers than in their circulating venous blood. Intraocular pressure was severely elevated, despite relatively small amounts of intracameral blood. Systemic hypotensive agents were not always successful in reducing IOP, and in patients with sickle cell hemoglobinopathy, are probably contraindicated in high or repeated dose regimens. Moderate elevation of IOP in sickle cell hemoglobinopathy patients may produce rapid deterioration of visual function, perhaps because of a greater than usual effect on vascular perfusion in the central retinal artery and optic nerve. Early anterior chamber paracentesis may be the best treatment for this type of hyphema-induced secondary glaucoma.

Adolescent↗
PubMed1975

Traumatic hyphema: surgical vs medical management.

We undertook a prospective study of traumatic hyphema during the years 1970 through 1972 to compare the effects of medical management and surgical evacuation in the more severe hyphemas. A protocol for sutdy of the two regimens enabled us to compare the results of therapy. The findings indicate that medical management is preferable for the initial 4 days in major hyphemas. Surgical intervention does not offer improvement in the poor prognosis of total hyphemas during this early period. The incidence of complications and the incidence of permanent poor visual results are higher in surgically treated patients than in those managed medically. Surgical intervention should be reserved for cases showing: (1) microscopic corneal blood staining; (2)total hyphemas with intraocular pressures of 50 mm Hg or more for 5 days (to prevent optic nerve damage); (3) hyphemas that are initially total and do not resolve below 50% at 6 days with intraocular pressures of 25 mm Hg or more (to prevent corneal blood staining); and (4) hyphemas that remain unresolved for 9 days (to prevent peripheral anterior synechiae). A brief review of problems that may be encountered in the various forms of surgical management is included in an effort to prevent repeating similar pitfalls.

Adult↗
PubMed1991

Intraocular tissue plasminogen activator in a rabbit model of traumatic hyphema.

Tissue plasminogen activator was used to evaluate the clearance of traumatic hyphema in a rabbit model. A neodymium-YAG laser was used to disrupt iris vessels, creating a traumatic hyphema. Tissue plasminogen activator (1800 IU/0.1 mL) was injected into the anterior chamber 24 hours after creation of the hyphema. Two control groups (one receiving balanced salt solution and one receiving no treatment) were used for comparison. A multivariate analysis of covariance indicated that the greatest difference in hyphema clearance between the groups occurred at days 3, 4, and 5. Five days after tissue plasminogen activator treatment, the mean size of the clot remaining in the anterior chamber was 27% of that of the original hyphema. In control eyes, almost 60% of the original clot remained at day 5. Treatment of animals with tissue plasminogen activator doses of 5000 IU and 10,000 IU produced a substantial increase in repeated bleeding episodes in our rabbit model. We concluded that although the use of tissue plasminogen activator in our rabbit model of traumatic hyphema significantly improved clearance of blood from the anterior chamber, the remaining clot was of such size that the clinical benefit was questionable.

Animals↗
PubMed1977

Recurrent traumatic hyphema. A sequel of injury to the Schlemm canal.

A patient with recurrent hyphema following blunt trauma to the left eye was found to have an angle recession with a laceration of the trabecular meshwork and Schlemm canal. Active bleeding from the Schlemm canal proved to be the cause of the recurrent hyphema. Repeated trials of bed rest and bilateral eye patching provided only temporary control of the bleeding. Cessation of the active bleeding and subsequent resolution of the hyphema was achieved following argon laser photocoagulation to the traumatized portion of the Schlemm canal. While hyphema is a common manifestation of blunt ocular trauma, visible rupture of the Schlemm canal is most unusual. This paper describes the gonioscopic findings of a rupture of the Schlemm canal in a patient who had a traumatic hyphema and recurrent bleeding.

Adult↗
PubMed1990

Rebleeding in experimental traumatic hyphema treated with intraocular tissue plasminogen activator.

Tissue plasminogen activator has recently been shown to enhance the clearance of experimental nontraumatic hyphema in animals. However, hyphema in human eyes usually results from ocular trauma, and rebleeding is a serious complication. Hemorrhage is also a potential complication of fibrinolytic therapy. We assessed the incidence of rebleeding in an animal model of surgically induced traumatic hyphema after intracameral injection of tissue plasminogen activator (25 micrograms) or physiological saline. Eight eyes were each treated with tissue plasminogen activator or physiological saline at 10 minutes, 24 hours, 48 hours, or 72 hours after injury. Controls were 8 eyes with hyphema but no intracameral injection. No eyes treated with physiological saline (total, 32 eyes) or control eyes rebled. In contrast, the incidence of rebleeding from the injury site in eyes treated with tissue plasminogen activator was 88% (7/8) at 10 minutes, 75% (6/8) at 24 hours, 50% (4/8) at 48 hours, and 0% (0/8) at 72 hours after injury. Treatment of traumatic hyphema with tissue plasminogen activator prior to healing of damaged vascular endothelium may contribute to rebleeding.

Animals↗
PubMed1975

Outcome of traumatic hyphema.

One hundred and twenty-seven cases of traumatic hyphema are reviewed and discussed according to a definite system of grading. Grade iii hyphemas have definitely a poorer prognosis than Grade ii and Grade i hyphemas. Rebleeding occurs more frequently when there is a delay in treatment but does not appear to affect the outcome of a traumatic hyphema. Blood staining of the cornea could be avoided by an adequate treatment started immediately after the trauma, thus decreasing the percentage of blindness following a traumatic hyphema.

Absorption↗
PubMed1988

Bed rest versus activity ad lib in the treatment of small hyphemas.

The management of small hyphemas remains controversial. Some authors advocate hospitalization, strict bed rest, and medical therapy with aminocaproic acid. Others are less conservative and recommend treatment on an ambulatory basis without the drug. In order to establish the overall rebleed rate for small hyphemas and to assess whether or not strict bed rest improves the prognosis, we studied 73 patients with small hyphemas occupying less than one third of the anterior chamber. Thirty-seven patients, during the first year of the study, were hospitalized and treated with strict bed rest while 36 patients, during the second year, were hospitalized but allowed to ambulate freely. The overall incidence of rebleeds was 15% (11 of 73). The incidence of rebleeds and other complications was not statistically different between the two study groups. Additionally, the final visual acuity in both groups was essentially identical. We conclude that bed rest does not improve the prognosis in cases of small hyphemas.

Atropine↗
PubMed1978

Late hyphema due to vascularization of the cataract wound.

Nineteen patients with hyphema due to fibrovascular tissue in the cataract wound were seen. In 3 patients the hyphema occurred after closure of an unitentional filtering bleb. Two patients receiving anticoagulants before and after the hyphema occurred did not have recurrence of the bleeding. In one patient the hyphema was induced by scleral depression. This benign condition is frequently misdiagnosed. When erythrocytes are seen in the anterior chamber of an aphakic patient, vascularization of the cataract wound should be suspected and confirmed by gonioscopy.

Adult↗
PubMed1987

Use of tissue plasminogen activator in experimental hyphema.

Tissue plasminogen activator (tPA) is a fibrin-specific fibrinolytic agent that has recently been shown to be effective in accelerating the clearance of fibrin clots from the rabbit anterior chamber. We studied the effect of intracameral tPA on the clearance of experimental hyphema in the rabbit. Fifteen eyes were treated with an intracameral injection of tPA (1800 IU), 11 eyes were treated with a physiologic saline solution (PS) injection, and 16 eyes received no injection. Total hyphemas treated with tPA showed 80% clearance within 24 hours, while eyes treated with PS and untreated eyes cleared in 14 days. Measurement of corneal thickness revealed the tPA-treated eyes to have less corneal edema than eyes treated with PS and untreated eyes. There was no difference in intraocular pressure. The results indicate that tPA is effective in accelerating the clearance of experimental hyphema.

Animals↗
PubMed1988

Topical aminocaproic acid significantly reduces the incidence of secondary hemorrhage in traumatic hyphema in the rabbit model.

Systemically administered aminocaproic acid has been shown to reduce the incidence of secondary hemorrhage after traumatic hyphema. To date, no topical treatment has been shown to be effective in reducing the incidence of rebleeding in a double-masked study. Experimentally induced traumatic hyphemas in the rabbit model were treated with topical placebo gel (4% carboxypolymethylene gel only) or carboxypolymethylene gel with amino-caproic acid (treated group) in a double-masked fashion and were compared with untreated controls (control group). In both the control and placebo groups, there was a 33% rebleed rate. The treated eyes had a 10% rebleed rate that is statistically significant. The topically applied aminocaproic acid gel appears to be well tolerated locally without evidence of systemic toxicity. This study indicates that topical aminocaproic acid may be an effective alternative to systemic treatment to reduce the incidence of secondary hemorrhage in traumatic hyphema.

Acrylic Resins↗
PubMed1976

Spontaneous hyphema associated with ingestion of aspirin and ethanol.

Unilateral hyphema, hematuria, and ecchymoses developed in a previously healthy 42-year-old women after the ingestion of aspirin and ethanol. There was no evidence for ocular trauma, disease, or vascular malformation by slit-lamp examination and gonioscopy. Platelet count and coagulation tests were normal. The patient's bleeding time was prolonged and there was impaired platelet aggregation. Delayed (secondary) aggregation in response to collagen, adenosine diphosphate, and epinephrine was decreased, as was aggregation induced by thrombin and serotonin. These data indicate that the qualitative platelet defect was induced by both aspirin and ethanol. Anterior chamber hemorrhage subsided after discontinuation of aspirin and ethanol, and the hyphema subsequently resolved. Bleeding time and platelet aggregation were normal two weeks after the patient's initial presentation. A prolonged bleeding time in association with normal platelet count, prothrombin time, and partial thromboplastin time indicated a qualitative platelet defect, which is most commonly drug-induced. Defective platelet function resulted in spontaneous hyphema.

Adenosine Diphosphate↗
PubMed1990

Traumatic hyphema in an urban population.

We reviewed 241 patients (178 black and 63 white) who were examined and treated at the Detroit Medical Center between 1980 and 1989 for traumatic hyphema. Secondary hemorrhage occurred in 46 patients (19%) and was significantly higher in black patients (P less than .005). Thirty-one patients (67%) developing secondary hemorrhage had an initial hyphema filling less than 25% of the anterior chamber. Patients treated with aminocaproic acid had secondary hemorrhages at a rate of 11% (six patients) compared to 21% (40 patients) in patients who were not treated with aminocaproic acid. The high risk of secondary hemorrhage with potential ocular damage in patients with traumatic hyphema, especially black patients, supports the benefit of hospitalization and the administration of aminocaproic acid.

Adolescent↗
PubMed1987

Traumatic hyphema in children. Treatment with epsilon-aminocaproic acid.

Forty-nine patients, ages 3 to 18 years, who sustained nonpenetrating unilateral trauma with hyphemas were assigned randomly to receive either 100 mg/kg of epsilon-aminocaproic acid (EACA), an antifibrinolytic agent, orally every 4 hours for 5 days (maximum 30 g/day) or a placebo. No patients ingested acetylsalicylic acid (ASA)-containing compounds before or during admission. Two patients of 24 treated with EACA and 1 of 25 given placebo had rebleeds. The hyphemas in the EACA-treated group took significantly longer to clear (mean, 5.3 versus 2.6 days; P less than 0.001). Because of the low incidence of rebleeds in the placebo group, the efficacy of EACA in reducing the rate of rebleeds could not be determined. Further studies with this drug, controlling for age, race, sickle trait, and pre-admission antiplatelet agents should be undertaken before its routine use in traumatic hyphema management can be recommended.

Adolescent↗
PubMed1992

Effect of a superficial and a deep scleral pocket incision on the incidence of hyphema.

Deep tunnel scleral pocket incisions were developed to control surgically induced astigmatism following cataract and intraocular lens implantation surgery. A more superficial, shallow scleral pocket incision was developed to reduce the rate of postoperative hyphema. To test its effectiveness, a randomized prospective clinical study was performed. One hundred twenty-nine eyes of 129 patients were randomized: 66 to receive a deep tunnel pocket and 63 to receive the superficial pocket. In both groups the incision was made 3 mm posterior to the limbus. For the deep pocket cases, a blade setting of 0.27 mm was used and the wound was dissected forward toward the entry site, creating a long, deep, narrow tunnel. For the superficial wound cases, a 0.17 mm blade setting was used and the entire wound was dissected to the edge of the anatomic limbus, creating a thin scleral flap. The left side was then fanned out toward the left with the entry site slightly into clear cornea. At one day after surgery, 22 cases (34%) in the deep pocket group and four cases (6%) in the superficial pocket group had hyphemas. The difference in hyphema rates was statistically significant (P less than .001).

Adult↗
PubMed1992

Sports-related traumatic hyphema.

Traumatic hyphema is a common sports-related eye injury that can cause permanent visual loss. Although referral to an ophthalmologist is advised, the primary care physician is often responsible for making the diagnosis and initiating medical care. A careful history should be taken and a physical examination performed, with attention given to possible accompanying ocular injuries. Proper positioning of the patient and placement of a unilateral eye shield are the first steps in management. Therapy is aimed at preventing secondary hemorrhage, elevated intraocular pressure and corneal blood staining. Surgical intervention may be necessary to preserve vision. Prognosis depends on the size of the hyphema, the development of complications and the presence of associated injuries. Protective eye guards have been shown to be very effective in preventing traumatic hyphema.

Athletic Injuries↗
PubMed1990

Idiopathic bilateral spontaneous hyphemas.

Spontaneous hyphemas are rare and usually associated with iris microhemangiomas or other vascular anomalies of the iris. In addition, various systemic problems can result in spontaneous hyphema. This is a case report of a bilateral spontaneous hyphema (recurrent in one eye), in which no predisposing condition could be identified after exhaustive hematologic evaluation and iris fluorescein angiography.

Female↗
PubMedDate not supplied

[Hyphema, a risk factor in the glaucomatous eye].

A hemorrhage in the anterior chamber is a frequent phenomenon, very often treated too easily. Our investigation followed for 3 years (1985-1987) the way in which hyphema were resorbed after the eye contusions in the patients operated by cataract or glaucoma. The causes of hyphemas, their onset, the aspect of the blood and the resorption period are analyzed. The majority of hyphemas were resorbed in the first 7 days (in the case of contusions 87%, after operation of cataract 84%) but in the glaucomatous patients the resorption in the first 7 days appeared only in 50% of the cases; the blood remained in the anterior chamber in 12.5% of cases even after 21 days. The blood in the anterior chamber is resorbed by the excretory ducts, mainly as intact erythrocytes; in the glaucomatous patients the ducts are altered and the erythrocytes are more difficulty eliminated. The liquid in the anterior chamber is eliminated by the fistulization opening, but the erythrocytes do not pass as they cannot be resorbed in the subconjunctival space. The blood in the anterior chamber of an eye with ocular hypertension (decompensated glaucoma or contusions with hypertension) favours the hematic impregnation of the cornea, and the macrophages loaded with hemosiderin are deposited at the level of the excretory ducts, thus increasing the danger of hemolytic secondary glaucoma.(ABSTRACT TRUNCATED AT 250 WORDS)

Cataract↗
PubMed1978

Recurrent hemorrhage in traumatic hyphema.

A retrospective review of hospital records reveals that over 90% of recurrent bleeds in traumatic hyphema occur at night. It is postulated that rapid eye movement (REM) sleep, with its displays of saccadic virtuosity, is the major reason for the nocturnal prevalence of such recurrent hyphemas. Theoretical considerations suggesting a more rational therapy of traumatic hyphema are presented and clinical trials are suggested.

Adolescent↗