Management of hyphema in patients with sickle cell disease or trait

Leffler, Christopher T.; Bharucha, Grishma; Donaldson, Jared C.

doi:10.1016/j.survophthal.2016.04.001

Cited by 6 publications

(4 citation statements)

References 6 publications

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“…Nonetheless, there is still considerable controversy regarding such an approach. 18 Traditionally, for patients with hyphema and sickle cell hemoglobinopathy, surgical intervention has been recommended if the IOP averages >24 mmHg over 24 hours, or if it repeatedly increases above 30 mmHg. 11 In general, the evidence behind this recommendation is limited.…”

Section: Discussionmentioning

confidence: 99%

<p>Clinical Characteristics and Outcomes of Hyphema in Patients with Sickle Cell Trait: 10-Year Experience at the Wilmer Eye Institute</p>

Mir¹,

Iftikhar²,

Seidel³

et al. 2020

OPTH

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Purpose: To report the clinical characteristics, complications, and outcomes of hyphema in patients with sickle cell trait (SCT). Design: Retrospective case series. Methods: Medical records of SCT patients (confirmed by hemoglobin electrophoresis) presenting with hyphema at the Wilmer Eye Institute over 10 years (January 2008 through December 2017) were reviewed in detail. Data were collected regarding etiology, demographics, clinical course and management. Main outcome measures included intraocular pressure (IOP) and visual acuity (VA). Results: A total of 14 black patients (males: 57%; median age: 20 years) were included in the study with a median follow-up of 4 months (range: 1 week to 6 years). Ten patients had traumatic hyphema with a mean presenting VA of approximately 1.10 logMAR (Snellen equivalent=20/250) and a mean presenting IOP of 40 mmHg. Nine of them required medical intervention to lower IOP, and six of them ultimately required surgical intervention, primarily in the form of anterior chamber paracentesis and/or washout. The mean time to achieve IOP control was 3 days, and the mean final VA was approximately 0.10 logMAR (Snellen Equivalent=20/25). Four patients had non-traumatic hyphema with a mean presenting VA of approximately 1.8 logMAR (Snellen equivalent=20/1260) and a mean presenting IOP of 31 mmHg. Three of them required medical intervention to lower IOP, and two of them ultimately required surgical intervention. Overall, seven patients underwent anterior chamber washout, six needed an anterior chamber paracentesis to lower the IOP, two required tube shunt placement procedures and one patient underwent a trabeculectomy. The mean time to achieve IOP control was 5 days, and the mean final VA was approximately 0.80 logMAR (Snellen equivalent=20/125). Conclusion: Patients with SCT are likely to develop elevated IOP in the setting of hyphema, with a majority requiring one or more surgical interventions to achieve IOP control.

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Section: Discussionmentioning

confidence: 99%

<p>Clinical Characteristics and Outcomes of Hyphema in Patients with Sickle Cell Trait: 10-Year Experience at the Wilmer Eye Institute</p>

Mir¹,

Iftikhar²,

Seidel³

et al. 2020

OPTH

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“…Ob bereits ein Augeninnendruck von 25 mmHg Anlass für chirurgische Interventionen (z. B. Parazentese und Vorderkammerspülung bei Hyphäma) geben sollte, ist jedoch umstritten [40]. Wichtig ist es, Carboanhydrasehemmer zu vermeiden, da die damit einhergehende systemische Dehy-dratation bzw.…”

Section: Behandlung Bei Erhöhtem Augeninnendruckunclassified

“…die Sichelzellbildung verstärken kann [20]. Dass dies auch für topisch applizierte Carboanhydrasehemmer (Dorzolamid, Brinzolamid) gelten könnte, ist denkbar -die Augentropfen könnten lokal in der Vorderkammer bei Hyphäma eine Sichelzellbildung verursachen mit Behinderung des Durchtritts der Sichelzellendurchdas Trabekelmaschenwerk-, konnte bisher jedoch nicht nachgewiesen werden [40].…”

Section: Behandlung Bei Erhöhtem Augeninnendruckunclassified

Makulopathie bei Sichelzellerkrankung

et al. 2021

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Zusammenfassung Hintergrund Die Sichelzellerkrankung (SZE) ist eine hereditäre Hämoglobinopathie, die durch rezidivierende vasookklusive Episoden zur Mikrozirkulationsstörung verschiedener Organsysteme mit teils letalem Ausgang führt. Bei der okulären Manifestation der SZE ist am bekanntesten die periphere Sichelzellretinopathie (SZR). Unabhängig davon kann es bereits früh im Krankheitsverlauf zur Sichelzellmakulopathie (SZM) kommen. Methoden Review der internationalen und deutschsprachigen Literatur zur okulären Beteiligung bei SZE mit Fokus auf die SZR und SZM sowie Überblick über aktuelle systemische Therapieansätze bei SZE anlässlich der Vorstellung zweier Patienten mit HbSS-SZE. Ergebnis und Schlussfolgerung Im Gegensatz zur SZR ist die SZM mit temporaler Verdünnung der inneren Netzhautschichten erst in den letzten 5 Jahren mit der Einführung von SD-OCT und OCTA vermehrt in die Literatur eingegangen. Unabhängig vom Vorliegen einer SZR kann es immerhin bei etwa der Hälfte der Patienten bereits früh im Krankheitsverlauf zu einer SZM kommen. Das Krankheitsbild wird auch in Deutschland durch den Fortschritt der systemischen Therapiemöglichkeiten und aufgrund von Migration präsenter werden. Durch Wissen um diese Komplikation der SZE kann eine frühzeitige Diagnosestellung erfolgen und unnötige Diagnostik vermieden werden.

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“…18 , 19 Studies have suggested surgical intervention for hyphemas of any size with IOP more than 24 mmHg for more than 24 hours in individuals with sickle cell trait or disease; 20 however, there is little scientific evidence supporting surgical interventions in these case scenarios. 21 The decision for medical and surgical management of these patients should be made on a case-by-case basis, until more evidence is readily available.…”

Section: Ophthalmological Manifestations Of Sickle Cell Diseasementioning

confidence: 99%

Hemoglobinopathies: ocular manifestations in children and adolescents

Moussa

Chen

2021

Ophthalmol Eye Dis

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Hemoglobinopathies are genetic disorders that lead to abnormal structure of the hemoglobin molecule. Sickle cell disease, the most common inherited blood disorder, is characterized by defective oxygen transport. Almost every part of the eye can be affected by sickle cell disease; however, proliferative sickle cell retinopathy is the primary cause of vision loss, either from vitreous hemorrhage or retinal detachment. Here we review the various manifestations of hemoglobinopathies on the eyes of children and adolescents, with a specific focus on sickle cell disease and its different phenotypes. Newer, more sensitive ophthalmological imaging modalities, including ultra-widefield fluorescein angiography, spectral-domain optical coherence tomography, and optical coherence tomography angiography, are available. These sensitive modalities allow for a more thorough examination of the retinal periphery where sickle cell retinopathy is often present. Utilization of such modalities will help with the early detection of the disease in children, which provide a better understanding of the pathogenesis of the disease and guide future screening and treatment regimens.

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Management of hyphema in patients with sickle cell disease or trait

Cited by 6 publications

References 6 publications

<p>Clinical Characteristics and Outcomes of Hyphema in Patients with Sickle Cell Trait: 10-Year Experience at the Wilmer Eye Institute</p>

<p>Clinical Characteristics and Outcomes of Hyphema in Patients with Sickle Cell Trait: 10-Year Experience at the Wilmer Eye Institute</p>

Makulopathie bei Sichelzellerkrankung

Hemoglobinopathies: ocular manifestations in children and adolescents

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