Shiuey Y, Lucarelli M J
Massachusetts Eye and Ear Infirmary, Harvard Medical School, Department of Ophthalmology, Boston 02114, USA.
Ophthalmology. 1998 May;105(5):851-5. doi: 10.1016/S0161-6420(98)95025-4.
This study aimed to compare the outcomes of outpatient and inpatient management of layered hyphema.
The charts of all patients with traumatic layered hyphema treated in the Massachusetts Eye and Ear Infirmary Emergency Ward between January 1991 and November 1995 were analyzed retrospectively. Patients with a diagnosis of microscopic hyphema, ruptured globe, or posterior segment injury other than commotio retinae on their initial emergency department visit were excluded. The study patients were compared with an historic control group of patients with hyphema who had been treated at the same institution from July 1986 to February 1989.
A total of 154 patients met the study criteria. These were compared with 119 patients in the historic control group.
Of the study patients, 5% were admitted on the day of presentation, 95% were treated initially as outpatients, and 4% subsequently were admitted. All of the patients in the historic control group were treated with initial hospital admission.
The rebleed rates of the study and control groups were compared. The final recorded visual acuity and causes of best-corrected visual acuity worse than 20/30 were analyzed for the study group.
The rebleed rates of the study group and the historic control group were 4.5% and 5.0%, respectively (P > 0.05). The rebleed rates of the study patients initially treated as outpatients and the historic control group were 3.4% and 5%, respectively (P > 0.05). The rebleed rates of study patients who did not receive aminocaproic acid and the subset of historic control patients who received aminocaproic acid were 3.3% and 4.8%, respectively (P > 0.05). Ninety-six percent of study patients achieved a final best-corrected visual acuity of 20/30 or better. Causes of a final documented visual acuity worse than 20/30 included loss of patient follow-up before resolution of the hyphema, traumatic cataract, macular hole, and macular degeneration.
In the authors' predominantly white patient population, close outpatient follow-up of traumatic hyphemas appears to be safe and effective. Hospitalization for hyphema does not appear to decrease the rate of rebleeding. Decreased vision in the setting of traumatic hyphema generally results from comorbidities not affected by inpatient management.
本研究旨在比较外伤性分层前房积血门诊治疗与住院治疗的效果。
对1991年1月至1995年11月在马萨诸塞州眼耳医院急诊科接受治疗的所有外伤性分层前房积血患者的病历进行回顾性分析。排除初次急诊就诊时诊断为显微镜下前房积血、眼球破裂或除视网膜震荡外的眼后段损伤的患者。将研究患者与1986年7月至1989年2月在同一机构接受治疗的前房积血历史对照组患者进行比较。
共有154例患者符合研究标准。将这些患者与历史对照组的119例患者进行比较。
在研究患者中，5%在就诊当天入院，95%最初作为门诊患者治疗，4%随后入院。历史对照组的所有患者最初均住院治疗。
比较研究组和对照组的再出血率。分析研究组最终记录的视力以及最佳矫正视力低于20/30的原因。
研究组和历史对照组的再出血率分别为4.5%和5.0%（P>0.05）。最初作为门诊患者治疗的研究患者和历史对照组的再出血率分别为3.4%和5%（P>0.05）。未接受氨基己酸治疗的研究患者和接受氨基己酸治疗的历史对照组患者子集的再出血率分别为3.3%和4.8%（P>0.05）。96%的研究患者最终最佳矫正视力达到20/30或更好。最终记录的视力低于20/30的原因包括前房积血消退前患者失访、外伤性白内障、黄斑裂孔和黄斑变性。
在作者以白人为主的患者群体中，对外伤性前房积血进行密切的门诊随访似乎是安全有效的。前房积血住院治疗似乎不会降低再出血率。外伤性前房积血情况下视力下降通常是由住院治疗无法影响的合并症导致的。
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