Lai J C, Fekrat S, Barrón Y, Goldberg M F
Wilmer Ophthalmological Institute, The Johns Hopkins Medical Institutions, 727 Maumenee Bldg, 600 N Wolfe St, Baltimore, MD 21287-9278, USA.
Arch Ophthalmol. 2001 Jan;119(1):64-70.
To identify risk factors associated with higher rates of ocular complications in children with traumatic hyphema.
Consecutive inpatient records from July 1990 through December 1997 were retrospectively reviewed for all children (aged < or = 18 years) who were admitted to the Wilmer Ophthalmological Institute, Baltimore, Md, within 48 hours of a closed-globe injury leading to hyphema. Data obtained included age, sex, race, sickle cell status, initial and final visual acuities, hyphema size and intraocular pressure at presentation, the occurrence of a secondary hemorrhage, subsequent intraocular pressure elevations, and therapeutic interventions.
Forty children fulfilled the inclusion criteria: 20 African American, 1 Asian American, and 19 white. Five of the 20 African American children had sickle cell trait, and 1 had sickle cell anemia. The rate of secondary hemorrhage was statistically higher in the African American population (P =.05), but no statistical difference existed between the rate of secondary hemorrhage in patients with and without sickle cell hemoglobinopathy. Sickle cell hemoglobinopathy was associated with a higher intraocular pressure at presentation (P =.03) and during inpatient follow-up (P =.02).
In the setting of traumatic hyphema, African American children appear to be at greater risk for developing a secondary hemorrhage. In our patients, sickle cell hemoglobinopathy increased the risk of intraocular pressure elevation, but did not seem to increase the risk of rebleeding beyond that associated with race. Larger studies are needed to validate these observations.
确定与外伤性前房积血患儿眼部并发症发生率较高相关的危险因素。
回顾性分析1990年7月至1997年12月期间，所有在马里兰州巴尔的摩市威尔默眼科研究所因闭合性眼球损伤导致前房积血而在48小时内入院的18岁及以下儿童的连续住院记录。获取的数据包括年龄、性别、种族、镰状细胞状态、初始和最终视力、就诊时前房积血大小和眼压、继发性出血的发生情况、随后的眼压升高以及治疗干预措施。
40名儿童符合纳入标准：20名非裔美国人、1名亚裔美国人和19名白人。20名非裔美国儿童中有5名具有镰状细胞性状，1名患有镰状细胞贫血。非裔美国人中继发性出血的发生率在统计学上更高（P = 0.05），但镰状细胞血红蛋白病患者和非患者之间继发性出血的发生率没有统计学差异。镰状细胞血红蛋白病与就诊时（P = 0.03）和住院随访期间（P = 0.02）较高的眼压相关。
在外伤性前房积血的情况下，非裔美国儿童似乎发生继发性出血的风险更大。在我们的患者中，镰状细胞血红蛋白病增加了眼压升高的风险，但似乎并没有增加再出血的风险，超出与种族相关的风险。需要更大规模的研究来验证这些观察结果。
