Traumatic hyphema in children - Risk factors for complications

Objective: To identify risk factors associated with higher rates of ocular complications in children with traumatic hyphema. Methods: Consecutive inpatient records from July 1990 through December 1997 were retrospectively reviewed for all children (aged less than or equal to 18 years) who were admitted to the Wilmer Ophthalmological Institute, Balt imore, Md, within 48 hours of a closed-globe injury leading to hyphema. Dat a obtained included age, sex, race, sickle cell status, initial and final v isual acuities, hyphema size and intraocular pressure at presentation, the occurrence of a secondary hemorrhage, subsequent intraocular pressure eleva tions, and therapeutic interventions. Results: Forty children fulfilled the inclusion criteria: 20 African Americ an, 1 Asian American, and 19 white. Five of the 20 African American childre n had sickle cell trait, and 1 had sickle cell anemia. The rate of secondar y 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. Sickl e cell hemoglobinopathy was associated with a higher intraocular pressure a t presentation (P=.03) and during inpatient follow-up (P=.02). Conclusions: 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 p ressure elevation, but did not seem to increase the risk of rebleeding beyo nd that associated with race. Larger studies are needed to validate these o bservations.