Medical interventions for traumatic hyphema

• Published in: Cochrane database of systematic reviews 2023-03, Vol.3 (3), p.CD005431-CD005431
• Main Authors: Woreta, Fasika A, Lindsley, Kristina B, Gharaibeh, Almutez, Ng, Sueko M, Scherer, Roberta W, Goldberg, Morton F
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Aminocaproic Acid - therapeutic use; Antifibrinolytic Agents - therapeutic use; Aspirin - therapeutic use; Glaucoma - drug therapy; Humans; Hyphema - drug therapy; Hyphema - therapy; Medicine General & Introductory Medical Sciences; Mydriatics - therapeutic use; Tranexamic Acid - therapeutic use
• ISSN: 1469-493X
• DOI: 10.1002/14651858.CD005431.pub5

Traumatic hyphema is the entry of blood into the anterior chamber, the space between the cornea and iris, following significant injury to the eye. Hyphema may be associated with significant complications that uncommonly cause permanent vision loss. Complications include elevated intraocular pressure, corneal blood staining, anterior and posterior synechiae, and optic nerve atrophy. People with sickle cell trait or disease may be particularly susceptible to increases in intraocular pressure and optic atrophy. Rebleeding is associated with an increase in the rate and severity of complications. To assess the effectiveness of various medical interventions in the management of traumatic hyphema. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2022, Issue 3); MEDLINE Ovid; Embase.com; PubMed (1948 to March 2022); the ISRCTN registry; ClinicalTrials.gov; and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). The last date of the search was 22 March 2022. Two review authors independently assessed the titles and abstracts of all reports identified by the electronic and manual searches. We included randomized and quasi-randomized trials that compared various medical (non-surgical) interventions versus other medical interventions or control groups for the treatment of traumatic hyphema following closed-globe trauma. We applied no restrictions on age, gender, severity of the closed-globe trauma, or level of visual acuity at time of enrollment. We used standard methodological procedures expected by Cochrane and assessed the certainty of evidence using GRADE. We included 23 randomized and seven quasi-randomized studies with a total of 2969 participants. Interventions included antifibrinolytic agents (systemic and topical aminocaproic acid, tranexamic acid, and aminomethylbenzoic acid), corticosteroids (systemic and topical), cycloplegics, miotics, aspirin, conjugated estrogens, traditional Chinese medicine, monocular versus bilateral patching, elevation of the head, and bed rest. We found no evidence of an effect on visual acuity for any intervention, whether measured within two weeks (short term) or for longer periods. In a meta-analysis of two trials, we found no evidence of an effect of aminocaproic acid on long-term visual acuity (RR 1.03, 95% confidence interval (CI) 0.82 to 1.29) or final visual acuity measured up to three years after t