Medical interventions not useful in managing traumatic hyphema

The researchers in a Cochrane Review found no evidence of successful management of visual acuity following traumatic hyphema by any of the medical interventions evaluated in the review.

Traumatic hyphema is blood entry into the anterior chamber of the eye. Hyphema uncommonly causes permanent loss of vision. Associated trauma (e.g. corneal staining, traumatic cataract, angle recession glaucoma, optic atrophy, etc.) may seriously affect vision. Such complications may result in permanent vision impairment. People with sickle cell trait/disease may be particularly susceptible to increases of elevated intraocular pressure. If rebleeding occurs, the rates and severity of complications increase.

Almutez Gharaibeh, Department of Special Surgery‐Ophthalmology, Faculty of Medicine, The University of Jordan, Amman, Jordan, and colleagues assessed the effectiveness of various medical interventions in the management of traumatic hyphema.

The study authors utilized a variety of search engines to obtain randomized and quasi-randomized trials assessing the efficacy of various medical interventions used in the treatment of traumatic hyphema following closed-globe trauma. Data were extracted for the primary outcomes of visual acuity and primary hemorrhage resolution time by 2 independent authors and were reported as risk ratios (RR) as well as mean differences (MD).

A total of 2643 patients from 20 randomized and 7 quasi-randomized trials were included in the review. Interventions included in the studies were: antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, aminomethylbenzoic acid), systemic and topical corticosteroids, cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular vs bilateral patching, elevating the head, as well as bed rest.

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Key Findings:

• The authors found no evidence of an effect on visual acuity for any intervention, whether measured within 2 weeks (short term) or for longer periods.


• In 2 trials evaluating aminocaproic acid, no evidence was found on its effect on long-term visual acuity (RR: 1.03; 95% CI: 0.82, 1.29) or final visual acuity up to 3 years following the hyphema (RR: 1.05; 95% CI: 0.93, 1.18).


• Data analysis also found that no intervention resulted in a statistically significant effect on short-term visual acuity (8 trials; RR: 0.75-1.10).


• Visual acuity measured for longer periods in 4 trials evaluating different interventions was also not statistically significant (RRs ranged from 0.82 to 1.02).


• Patients treated with antifibrinolytic agents were less likely to experience recurrent hemorrhage, but the hyphema took longer to resolve in those treated with systemic aminocaproic acid compared with no use.

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"Although evidence was limited, it appears that people with traumatic hyphema who receive aminocaproic acid or tranexamic acid are less likely to experience secondary hemorrhaging. However, hyphema took longer clear in people treated with systemic aminocaproic acid," write the authors.

"There is no good evidence to support the use of antifibrinolytic agents in the management of traumatic hyphema other than possibly to reduce the rate of secondary hemorrhage. Similarly, there is no evidence to support the use of corticosteroids, cycloplegics, or non‐drug interventions (such as binocular patching, bed rest, or head elevation) in the management of traumatic hyphema, they concluded, adding that, "As these multiple interventions are rarely used in isolation, further research to assess the additive effect of these interventions might be of value."

For further reference follow the link: 10.1002/14651858.CD005431.pub4