Coats D K, Viestenz A, Paysse E A, Plager D A
Cullen Eye Institute, Baylor College of Medicine, Houston, Texas, USA.
Binocul Vis Strabismus Q. 2000;15(2):169-74.
There are no outcome reports in the literature for outpatient management of traumatic hyphemas in children. Therefore we studied such cases at our institutions.
Retrospective chart review.
25 children less than 16 years of age with grade I traumatic hyphemas.
Inactivity at home with frequent office visits to monitor progress and complications. Treatment otherwise varied but virtually all patients received protective eye shields and topical steroids.
Rate of rebleeding and final visual acuity.
Three patients (12%) suffered a rebleed; one required surgery for clot evacuation. One of the three did not receive topical steroids and if he is excluded, rebleed rate is 2/24 or 8.3%. The hyphema resolved without sequelae in the other 22 patients. All patients had a final visual acuity of 20/40 or better except three patients (12%) who had concurrent vision-limiting ocular injuries and/or disease. Final visual acuity was 20/30 or better in all three patients with rebleeds.
Our rebleed rate was within the broad range of rebleed rates reported in the literature. However, improved efforts to identify children at highest risk for rebleeding, to maximize compliance with treatments, and to consider systemic agents in selected cases, could further reduce the rebleed rate and increase acceptance and safety of outpatient management in pediatric traumatic hyphemas.
文献中尚无关于儿童外伤性前房积血门诊治疗结局的报告。因此，我们在本机构对这类病例进行了研究。
回顾性病历审查。
25名16岁以下的I级外伤性前房积血患儿。
在家中休息，频繁到门诊复诊以监测病情进展和并发症。其他治疗方法各不相同，但几乎所有患者都接受了保护性眼罩和局部类固醇治疗。
再出血率和最终视力。
3例患者（12%）发生再出血；1例需要手术清除血块。这3例中有1例未接受局部类固醇治疗，若将其排除，再出血率为2/24，即8.3%。其他22例患者的前房积血消退，无后遗症。除3例（12%）有同时存在的限制视力的眼外伤和/或疾病的患者外，所有患者的最终视力均为20/40或更好。所有3例再出血患者的最终视力均为20/30或更好。
我们的再出血率在文献报道的广泛范围内。然而，进一步努力识别再出血风险最高的儿童，最大限度地提高治疗依从性，并在特定病例中考虑使用全身药物，可能会进一步降低再出血率，并提高小儿外伤性前房积血门诊治疗的接受度和安全性。
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