TOPICAL AMINOCAPROIC ACID IN THE TREATMENT OF TRAUMATIC HYPHEMA

Objectives: To determine whether topically applied aminocaproic acid, like systemic aminocaproic acid, effectively reduces secondary hemorrh age after hyphemas and to compare the safety and effectiveness of topi cal application with those of systemic use and a control group. Design : A prospective, randomized, double-masked, multicenter study. Patient s: Sixty-four patients with traumatic hyphema treated with topical or systemic aminocaproic acid and compared with 54 control patients with hyphema. Daily slitlamp examinations for hyphema grading and corneal c larity, initial and final visual acuity, applanation tonometry, and fu ndus indirect ophthalmoscopy were studied. Follow-up was 6 months to 5 1/2 years (mean, 2.96 years) Results: Compared with the control group , topical and systemic aminocaproic acid was statistically significant in preventing secondary hemorrhage. Only 3% (2/64) of the patients wh o received topical or systemic aminocaproic acid had secondary hemorrh age compared with 22% (12/54) of the control group (P=.002). Final vis ual acuity was 20/40 or better in 30 patients (86%) in the topical gro up compared with 23 patients (43%) in the control group (P<.001). Fina l visual acuity was 20/40 or better in 20 patients (69%) in the system ic aminocaproic acid group compared with 23 patients (43%) in the cont rol group (P=.04). The topical aminocaproic acid group had a final vis ual acuity of 20/40 or better in 86% of patients, compared with 69% of patients in the systemic group. Conclusions: Topical aminocaproic aci d appears to be a safe, effective treatment to prevent secondary hemor rhage in traumatic hyphema. It is as effective as systemic aminocaproi c acid in reducing secondary hemorrhage. No systemic side effects were observed with topical use. Topical aminocaproic acid provides an effe ctive outpatient treatment for traumatic hyphemas.