TRAUMATIC HYPHEMA - OUTCOMES OF OUTPATIENT MANAGEMENT

Objective: This study aimed to compare the outcomes of outpatient and inpatient management of layered hyphema. Design: The charts of all pat ients with traumatic layered hyphema treated in the Massachusetts Eye and Ear Infirmary Emergency Ward between January 1991 and November 199 5 were analyzed retrospectively. Patients with a diagnosis of microsco pic hyphema, ruptured globe, or posterior segment injury other than co mmotio retinae on their initial emergency department visit were exclud ed. The study patients were compared with an historic control group of patients with hyphema who had been treated at the same institution fr om July 1986 to February 1989, Participants: A total of 154 patients m et the study criteria. These were compared with 119 patients in the hi storic control group. Intervention: Of the study patients, 5% were adm itted on the day of presentation, 95% were treated initially as outpat ients, and 4% subsequently were admitted. All of the patients in the h istoric control group were treated with initial hospital admission. Ma in Outcome Measures: The rebleed rates of the study and control groups were compared. The final recorded visual acuity and causes of best-co rrected visual acuity worse than 20/30 were analyzed for the study gro up. Results: The rebleed rates of the study group and the historic con trol group were 4.5% and 5.0%, respectively (P > 0.05). The rebleed ra tes of the study patients initially treated as outpatients and the his toric control group were 3.4% and 5%, respectively (P > 0.05), The reb leed rates of study patients who did not receive aminocaproic acid and the subset of historic control patients who received aminocaproic aci d were 3.3% and 4.8%, respectively (P > 0.05). Ninety-six percent of s tudy patients achieved a final best-corrected visual acuity of 20/30 o r better. Causes of a final documented visual acuity worse than 20/30 included loss of patient follow-up before resolution of the hyphema, t raumatic cataract, macular hole, and macular degeneration. Conclusions : In the authors' predominantly white patient population, close outpat ient follow-up of traumatic hyphemas appears to be safe and effective. Hospitalization for hyphema does not appear to decrease the rate of r ebleeding. Decreased vision in the setting of traumatic hyphema genera lly results from comorbidities not affected by inpatient management.