Traumatic hyphema

Investigation of Retinal Vascular Parameters and Choroidal Vascular Index in Patients Developing Hyphema After Unilateral Blunt Trauma

BACKGROUND

To evaluate retinal and choroidal vascular changes in cases with hyphema after blunt ocular trauma that did not cause globe rupture or any retinal pathology.

METHODS

This cross-sectional study included 29 patients who developed hyphema after unilateral blunt ocular trauma (BOT). The other healthy eyes of the same patients were evaluated as the control group. Optical coherence tomography-angiography (OCT-A) was used for imaging. In addition, choroidal parameters were compared by calculating the choroidal vascular index (CVI) and using choroidal thickness measurements by two independent researchers.

RESULTS

Superior and deep flow values were significantly decreased in the traumatic hyphema group compared to the control group (p<0.05). Parafoveal deep vascular density (parafoveal dVD) values were decreased in traumatized eyes compared to control eyes (p=0.000). Vascular density values were similar other than that. In addition, there was a significant decrease in optic disc blood flow (ODF) and optic nerve head density (ONHD) values compared to the control group (p<0.05). In addition, no significant difference was observed between the groups in terms of mean CVI values (p>0.05).

CONCLUSION

Non-invasive diagnostic tools such as OCTA and EDI-OCT can be used to detect and monitor early changes in retinal and choroidal microvascular flow in cases of traumatic hyphema.

Comparison of Both Eyes Anterior Segment Structures of Patients with Unilateral Blunt Trauma

BACKGROUND

To evaluate anterior segment optical coherence tomography (AS-OCT) data in patients with unilateral blunt ocular trauma (BOT), to determine the relationship of results with hyphema development METHODS: 21 patients who received unilateral BOT were included in the study. Healthy eyes of patients were included in the control group. Iris stromal thickness (IST), schlemm canal area (SCA) and pupil diameter were measured by AS-OCT of the participants. In addition, eyes with ocular trauma were divided into those with and without hyphema and compared in terms of these parameters.

RESULTS

The mean nasal and temporal (n-t) IST was measured as 373± 40 µm and 369 ± 35 µm in BOT in comparison with 344 ± 35 µm and 335 ± 36 µm in control eyes, respectively (p = 0.000 and p = 0.001, respectively). The mean nasal and temporal (n-t) SCA was measured as 12,571 ± 880 µm² and 12,162 ± 1,181 µm² in developed hyphema in comparison with 10,455 ± 1,506 µm² and 10,188 ± 939 µm² in did not develop hyphema, respectively (p = 0.016 and p = 0.002 respectively).

CONCLUSION

The ISTs of the traumatized eyes in the nasal and temporal quadrants were statistically thicker than the other healthy eyes. SCA in both nasal and temporal quadrants of eyes with hyphema was statistically significantly larger than the group without hyphema.

Spontaneous Hyphema and Vitreous Hemorrhage Causing Secondary Glaucoma in a Patient on Apixaban

BACKGROUND

Spontaneous hyphema is the rare occurrence of hemorrhage within the anterior chamber of the eye without a predisposing traumatic event. Hyphema can be associated with acute elevations in intraocular pressure in up to 30% of cases, which poses a significant risk for permanent vision loss if not quickly recognized and treated in the emergency department (ED). Anticoagulant and antiplatelet medications have been previously associated with cases of spontaneous hyphema; however, there are limited reports of hyphema with associated acute glaucoma in a patient taking a direct oral anticoagulant. Due to the limited data of reversal therapies for direct oral anticoagulants in intraocular hemorrhage, these patients pose a challenge in deciding whether to reverse anticoagulation in the ED.

CASE REPORT

We present a case of a 79-year-old man on apixaban anticoagulation therapy who presented to the ED with spontaneous painful vision loss in the right eye with associated hyphema. Point-of-care ultrasound revealed an associated vitreous hemorrhage, and tonometry was significant for acute glaucoma. As a result, the decision was made to reverse the patient's anticoagulation with four-factor activated prothrombin complex concentrate. Why Should an Emergency Physician Be Aware of This? This case is an example of acute secondary glaucoma due to a hyphema and vitreous hemorrhage. There is limited evidence regarding anticoagulation reversal in this setting. A second site of bleeding was identified by utilization of point-of-care ultrasound, which led to the diagnosis of a vitreous hemorrhage. This allowed for shared decision-making between the emergency physician, ophthalmologist, and patient regarding the risks and potential benefits of the reversal of anticoagulation. Ultimately, the patient decided to have his anticoagulation reversed to try and preserve vision.

Bilateral Hyphema - An Unexpected Complication of Exercise Resistance Band Use: A Case Report

BACKGROUND

Resistance bands commonly used for strength training exercise come with an unexpected risk for ocular trauma.

CASE REPORT

In this report, we describe an unintended consequence of a 28-year-old man sustaining an unusual injury-bilateral hyphema-as a result of the use of elastic resistance bands. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Resistance bands are commonly used for strength training exercise and, in this case, a potentially severe, vision-threatening injury-traumatic hyphema-occurred. Traumatic hyphema occurs when blood pools in the anterior chamber of the eye, usually as the result of blunt force trauma or penetrating injury. Early recognition of this condition is imperative, as complications of traumatic hyphema, such as intraocular hypertension or rebleeding, can lead to permanent vision loss.

Incidence of and Risk Factors for Postoperative Hyphema After 23-Gauge Pars Plana Vitrectomy for Proliferative Diabetic Retinopathy

Purpose

We aim to investigate the incidence, clinical course, and risk factors for developing postoperative hyphema after 23-gauge pars plana vitrectomy (PPV) for patients with proliferative diabetic retinopathy (PDR) without neovascularization of the iris or angles and neovascular glaucoma (NVG).

Methods

This retrospective study included 155 consecutive eyes from 124 patients with at least three-month follow-up who underwent PPV for PDR without neovascularization of the iris or angles and NVG. Demographic data, surgery notes, postoperative hyphema assessment, intraocular pressure (IOP), and the surgical outcome were recorded.

Results

Postoperative hyphema occurred in 18 of 155 eyes (11.6%), with 14 of those having hyphema on day 1, and 4 having hyphema on days 7–20. Of the 18 eyes, only 3 (16.7%) had normal IOP, and immediate intraocular hypertension was observed in 15 (83.3%). Seven eyes required anterior chamber paracentesis and five needed anterior chamber irrigation. The average time for absorption of the hyphema was 13.1 days, and IOP was controlled in all cases. There was a significant correlation between membrane removal and the development of hyphema (OR = 5.65 and 95% CI: 1.190–25.203; p = 0.013). No recurrence of hyphema was observed. In patients with hyphema, the final best corrected visual acuity (BCVA) was 1.75 ± 0.84 logMAR, which improved significantly compared to the initial BCVA of 2.20 ± 0.65 logMAR (t = 3.893; p = 0.001), and the final anatomic success rate was 100%.

Conclusion

The development of hyphema is not uncommon after PPV for patients with PDR without neovascularization of the iris or angles and NVG, and membrane removal is a risk factor for postoperative hyphema. The timely management of hyphema ensures that hyphema does not affect the visual recovery or the final anatomical success.

Eye trauma in boxing

In boxing, along with a few other sports, trauma is inherent to the nature of the sport; therefore it is considered a high-risk sport for ocular injuries. The long-term morbidity of ocular injuries suffered by boxers is difficult to estimate due to the lack of structured long-term follow-up of these athletes. Complications of blunt ocular trauma may develop years after the athlete has retired from the ring and is no longer considered to be at risk for boxing-related injuries. This article describes the wide range of eye injuries a boxer can sustain, and their immediate and long-term clinical management.

Contemporary aspects in the prognosis of traumatic hyphemas

Purpose:

The present study concerns traumatic hyphemas and their prognostic factors and signs. The aim of this study is to determine the prognostic factors and signs of traumatic hyphemas.

Methods:

During the last five years, 72 young individuals were hospitalized with the diagnosis of suffering a traumatic hyphema and were divided in three groups according to the extent of their hyphema. The first group concerns 38 patients with a small hyphema 3–4 mm, the second group concerns 22 patients with moderate hyphema reaching the pupillary border, and the third group concerns 12 patients with a total hyphema.

Results:

The hyphema was absorbed in 63 patients and the IOP was controlled with medical treatment after 3–24 days. However, surgical management was necessary for two patients. Finally, antiglaucomatous treatment was administered in seven patients with persistent high intraocular pressure.

Conclusions:

The important clinical signs that determine the prognosis of such hyphemas are the size of hyphema, the blood color, recurrent hemorrhage, the absorption time, the increase of intraocular pressure, and blood staining of the cornea.

Outpatient management of traumatic hyphema in children: prospective evaluation

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.