Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Acta Ophthalmol. 2021 May;99(3):e394-e401. doi: 10.1111/aos.14603. Epub 2020 Oct 29.
To characterize the epidemiology and outcomes of hyphema.
Retrospective case series. Medical records from patients with traumatic and spontaneous hyphema seen at the Wilmer Eye Institute, Johns Hopkins, from 2011 through 2017 were evaluated. Aetiology, demographics, clinical characteristics, complications, management and outcomes were ascertained. Multivariable logistic regression was used to identify factors associated with elevated intraocular pressure (IOP), rebleeding and poor outcome (final visual acuity ≤ 20/40) in traumatic hyphema. A safe frequency of follow-up was retrospectively determined.
Traumatic hyphema (n = 152) was more common in males (78%) and adults (55%), with sports/recreational activities being the most frequent cause (40%). Elevated IOP was the most common complication (39%). Rebleeding occurred in seven patients (5%) and was more likely with a higher IOP on presentation (OR:1.1; p = 0.004). Thirty-seven patients (24%) had a poor outcome, mostly due to traumatic sequelae such as cataract (32%) or posterior segment involvement (30%). A poor outcome was more likely with worse presenting visual acuity (OR: 9.1; p = 0.001), rebleeding (OR: 37.5; p = 0.035) and age > 60 years (OR: 16.0; p = 0.041). Spontaneous hyphema (n = 28) did not have a gender predominance and was more common in adults > 60 years (71%). The most common cause was iris neovascularization (61%). Complications and visual outcomes were worse compared with traumatic hyphema.
Traumatic hyphema continues to be common in young males engaging in sports, necessitating increased awareness for preventive eyewear. Older age and rebleeding can lead to poor outcomes. Elevated IOP at presentation predisposes to rebleeding and warrants frequent follow-up. Otherwise, routine follow-up at days 1, 3, 5, 7 and 14 is sufficient for uncomplicated cases.
描述血影细胞性青光眼的流行病学和结局。
回顾性病例系列研究。对 2011 年至 2017 年期间在约翰霍普金斯威尔默眼科研究所就诊的外伤性和自发性血影细胞性青光眼患者的病历进行评估。确定病因、人口统计学、临床特征、并发症、治疗方法和结局。多变量逻辑回归用于确定外伤性血影细胞性青光眼患者眼压升高、再出血和预后不良（最终视力≤20/40）的相关因素。回顾性确定了安全的随访频率。
外伤性血影细胞性青光眼（n=152）更常见于男性（78%）和成年人（55%），最常见的病因是运动/娱乐活动（40%）。眼压升高是最常见的并发症（39%）。7 名患者（5%）发生再出血，且初次就诊时眼压升高者更有可能发生再出血（OR：1.1；p=0.004）。37 名患者（24%）预后不良，主要是由于外伤性后遗症，如白内障（32%）或后段受累（30%）。初次就诊时视力较差（OR：9.1；p=0.001）、再出血（OR：37.5；p=0.035）和年龄>60 岁（OR：16.0；p=0.041）与预后不良的相关性更大。自发性血影细胞性青光眼（n=28）无性别优势，更常见于>60 岁的成年人（71%）。最常见的病因是虹膜新生血管（61%）。与外伤性血影细胞性青光眼相比，并发症和视力结果更差。
外伤性血影细胞性青光眼在从事运动的年轻男性中仍然很常见，需要提高对预防眼镜的认识。年龄较大和再出血可导致不良结局。初次就诊时眼压升高易发生再出血，需要频繁随访。否则，无并发症的情况下，在第 1、3、5、7 和 14 天常规随访即可。
