Systemic Steroids: An Alternative to Systemic Aminocaproic Acid to Prevent Rebleeding in Traumatic Hyphema-Reply

In Reply. —The effectiveness of aminocaproic acid in preventing secondary hemorrhage in traumatic hyphemas has been demonstrated both in a prospective, randomized, double-masked, controlled clinical study 1 and in basic pharmacologic studies. 2 Three additional clinical studies and one animal model have confirmed these results. 3-6 The secondary hemorrhage rate in these studies with placebo was very similar (28% to 33%). The rate of secondary hemorrhage in those patients treated with aminocaproic acid was 0% to 4%. These scientific studies by different authors at different institutions provide ample scientific evidence to support the use of aminocaproic acid in the treatment of traumatic hyphema. Dr Romano has suggested the use of systemic steroids in traumatic hyphema treatment to circumvent the problems with aminocaproic acid. Unfortunately, there is little basic pharmacologic research to support his claim. Low concentrations of glucocorticoids have been demonstrated to retard the ability of neutrophils to promote conversion