Traumatic Hyphema - Comparison between Different Treatment Modalities

Background: This prospective, randomised study was performed to determine the best treatment available for mild noncomplicated traumatic hyphema. Method: This study comprised 120 patients who fulfill the criteria of our study. The patients were admitted in our center through the eye casualty department and they were randomly divided into three equal and similar groups, one group received Predforte ® eye drops, the other received Predforte ® and Cyclogel ® 1% eye drops and the control group received Tears Natural ® eye drops. For each patient, the following characteristics were recorded at presentation: age, sex, size of hyphema, initial visual acuity (IVA), intraocular pressure (IOP) and fundus examination. The outcome, hyphema resorption time, and occurrence of complications such as rebleeding and secondary glaucoma were recorded and compared between the groups. Results: The resorption time was almost the same (4 days) regardless of the treatment modality the patient received. Four (3.3%) patients developed a rebleed, two (5%) in the first (steroid only) group and 2 (5%) in the third (control) group. The final visual acuities (FVA) were 0.3 log MAR on discharge, the mean log MAR is 0.1.P value of (0.04). The cause of the decline in final visual acuity in these 4 patients was the development of traumatic cataract rather than the treatment used. A total of 14 patients (11.6 %) developed a mild to moderate elevation of IOP (23-29 mmHg); 10 (25%) in the first (steroid only) group, 2 (5%) in the second (steroid cyclo) group and 2 (5%) in the third (control) group. In all cases, the IOP returned to normal either without treatment or with short term Timolol eye drops. Conclusion: In cases of mild simple traumatic hyphemas not exceeding 50%, simple lubricating drops probably is most efficient and safe treatment. Using other drops such as Predforte and Cyclopentolate did not have any addional beneficiary effect.