Ocular Morbidity of Traumatic Hyphema in a Jamaican Hospital

Abstract

To determine the outcome of patients with hyphema secondary to ocular contusion. A retrospective review of the ophthalmic records of 44 consecutive patients with traumatic hyphema secondary to ocular trauma presenting to the Eye Clinic of the University Hospital of the West Indies between May 2004 and November 2007. The mean age was 21 years (95% confidence interval [CI] 16.4-25.5 years). Follow-up ranged from 2 weeks to 22 months. The most common mechanism of injury was impact by a missile and 41% occurred at home. The mean visual acuity at presentation was logMAR 1.85 (95% CI 1.4-2.3) and at 3 months improved to logMAR 0.63 (95% CI 0.3-1.0). The presenting intraocular pressure (IOP) ranged from 7-64 mmHg with 45.4% (20/44) having IOP of greater than 21 mmHg; 18% had the sickle cell trait. A total of 72.7% of patients presented with a grade I hyphema. Surgical intervention was indicated in 20.5% (9/44), which included anterior chamber paracentesis/washout and trabeculectomy. The most frequent complications were secondary glaucoma (32.4%), angle recession (23.5%), cataract (20.6%), and commotio retinae (20.6%). In the sickle cell group, 80% presented with elevated IOP (29-64 mmHg) and 70% had complications. A total of 94.7% of patients had an IOP <21 mmHg at 3 months. Traumatic hyphema is a recognized cause of significant visual disability. Improved visual acuity was attained after 3 months. The presenting visual acuity correlated with the visual prognosis. Patients with posterior segment complications tended to have poorer visual outcomes. The presence of the sickle cell gene increased the risk of secondary glaucoma.