The Management of Traumatic Hyphema

Endo, Eric G.; Mead, Mariana D.

doi:10.1097/00004397-199403430-00003

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“…A hemorragia é tamponada pelo aumento da pressão intra-ocular, vasoespasmo e formação de coágulo de fibrina e plaquetas. A integridade máxima do coá-gulo é alcançada dentro de quatro a sete dias, sendo os produtos de degradação da fibrina drenados através do trabeculado (5) . A classificação do hifema permite a avaliação da severidade da lesão, prognóstico e conduta.…”

Section: Discussionunclassified

“…Dos pacientes que tiveram AV final melhor que 6/60, 147 (75%) apresentavam hifema grau I e 9% dos pacientes apresentavam hifema microscópico (6) . O tratamento do hifema ainda permanece controverso (4)(5) . Preconiza-se repouso, decúbito a 30 graus e aumento da ingesta hídrica (3)(4) .…”

Section: Discussionunclassified

“…Os corticosteróides tópicos podem reduzir a irite traumática e em casos de aumento abrupto da pressão intraocular os hipotensores tópicos estão indicados. Os mióticos são contra-indicados, pois podem intensificar o processo inflamatório (5) . A incidência de ressangramento no estudo foi de 8%, sendo a mesma estimada em 3,5% a 38% (3)(4) .…”

Section: Discussionunclassified

“…Os principais mecanismos de desenvolvimento do glaucoma secundário incluem: recessão angular, sinéquias periféricas anteriores, sinéquias posteriores com formação de íris "bombé", e glaucoma de células fantasmas. Três pacientes (6%) evoluí-ram com aumento crônico e refratário da Po, correlacionandose à incidência estimada (5) , sendo submetidos à TREC sem intercorrências.…”

Section: Discussionunclassified

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Hifema traumático: seguimento de um ano

Rocha¹,

Engel²,

Gusmão³

et al. 2004

Arq. Bras. Oftalmol.

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Purpose:To evaluate the evolution of the patients with hyphema resulting from blunt ocular trauma associated with initial and final visual acuity, elevated intraocular pressure, rebleeding, clot absorption and surgical intervention. Methods: Fifty-four patients aged more than fifteen years, with blunt ocular trauma attended on the Ophthalmology Emergency Room of São Paulo Hospital were studied, between December 2000 to January 2002. The hyphema was classified in to five groups: microscopic; grade I; grade II; grade III; and grade IV (total hyphema). The patients were divided into two groups according to the involvement or not of the posterior segment. The data were compared by MannWhitney and the exact Fisher test and the final visual acuity was evaluated by multiple linear regression. Results: Ninety-one percent of the patients were men with an average age of thirty two years. At admission, 37% of patients showed intraocular pressure more than 24 mmHg. During the evolution, six patients required surgical intervention. Rebleeding occurred in 8% of the cases. In Group 1 (no lesions in the posterior segment) a better finally V.A. was statistically significant (p<0.001), a fact not observed in Group 2 (p<0.4772). Conclusion: Hyphema classification allows to evaluate the severity of damages, prognosis and management. The treatment still remains controversial. The final low visual acuity occurs more commonly associated with posterior segment injuries, and V.A. on admission. The successful treatment depends on identification of risk factors, appropriate medications and precise surgery indication.

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Section: Discussionunclassified