Table 2.
Outcomes by initial hyphema severity
| Study | Severity scale | Reported severity | Secondary hemorrhage | Other outcomes |
|---|---|---|---|---|
| Oral aminocaproic acid vs. control | ||||
| Christianson 1979 | NR | NR | NR | Time to resolution of the primary hyphema was significantly longer (P value < 0.05) for patients receiving drug in which the hyphema filled more than ½ of the anterior chamber |
| Crouch 1976 | Blood filling < ⅓ of anterior chamber | Reported no statistically significant differences across groups | NR | NR |
| Blood filling ⅓ to ½ of anterior chamber | ||||
| Blood filling > ½ to ¾ of anterior chamber | ||||
| Blood filling > ¾ to total of anterior chamber, but excluded total hyphema | ||||
| Kraft 1987 | Blood filling < ⅓ of anterior chamber | 30/49 (61%) participants; 13/24 (54%) in drug group; 17/25 (68%) in placebo group | 1/3 (33%) secondary hemorrhage (in placebo group) | Excluding secondary hemorrhages, mean time to resolution of 3.4 days in drug group (range 1–11 days); mean time to resolution of 2.2 days in placebo group (range 1–4 days) |
| Blood filling ⅓ to ½ of anterior chamber | 14/49 (29%) participants; 9/24 (37.5%) in drug group; 5/25 (20%) in placebo group | 1/3 (33%) secondary hemorrhage (in drug group) | Excluding secondary hemorrhages, mean time to resolution of 7.1 days in drug group (range 6–9 days); mean time to resolution of 4.0 days in placebo group (range 3–4 days) | |
| Blood filling ½ or more of anterior chamber | 5/49 (10%) participants; 2/24 (8.3%) in drug group; 3/25 (12%) in placebo group | 1/3 (33%) secondary hemorrhage (in drug group) | Excluding secondary hemorrhages, time to resolution of 10 days in drug group: mean of placebo 4. 3 days (range 3–5 days) | |
| Kutner 1987 | Mean hyphema height | 2.2 mm (SD 1.7, n = 21) in drug group; 1.7 mm (SD 1.0, n = 13) in placebo group | “All who rebled had initial hyphemas of 15% or less” | NR |
| McGetrick 1983; | Mean hyphema height | 100% (28/28) hyphemas in drug group were < 25% of anterior chamber; 86% (18/21) hyphemas in placebo group were < 25% of anterior chamber | 1 secondary hemorrhage in drug group; 6 secondary hemorrhages in placebo group | NR |
| Teboul 1995 | Blood filling < ⅓ of anterior chamber | 88/94 (94%) participants; 44/48 (92%) in drug group; 44/46 (96%) in placebo group | 1 secondary hemorrhages in drug group and 2 in placebo group | NR |
| Blood filling ⅓ to ½ of anterior chamber | 6/94 (6%) participants; 4/48 (8%) in aminocaproic acid group; 2/46 (4%) in placebo group | No rebleeds | NR | |
| Topical aminocaproic acid vs. control | ||||
| Karkhaneh 2003 | Blood filling < ¼ of anterior chamber; excluded microscopic hyphemas | 65/80 (81%) participants; 34/41 (83%) in drug group; 31/39 (79.5%) in placebo group | Reported no effect of hyphema size on secondary hyphema (RR 0.7, 95% CI 0.2 to 2.5) | NR |
| Blood filled ¼ to ½ of anterior chamber | 14/80 (18%) participants; 7/41 (17%) in drug group; 7/39 (18%) in placebo group | |||
| blood filling > ½ of anterior chamber; excluded total or blackball hyphemas | 1/80 (1%) participants; 0/41 in drug group; 1/39 (2. 5%) in placebo group | |||
| Pieramici 2003 | Mean hyphema height in mm | 1 mm (SE 0) in drug group (range 0–4 mm); 2 mm (SE 0) in placebo group (range 0–8 mm) | Size of primary hyphema in 2 participants with secondary hemorrhages in drug group: 0.3 and 1 mm; in 8 participants in the placebo group: 0.8, 0. 9, 1, 1.4, 1.8, 2, 2, and 4. 5 mm | NR |
| Low-dose vs. standard-dose aminocaproic acid | ||||
| Palmer 1986 | Mean hyphema height in mm | 1.7 mm (SD 2.0, range 0. 1–9.9) in low-dose group (n = 25); 1.5 mm (SD 2. 2, range 0.1–9.9) in standard-dose group; 1.5 mm in standard-dose group (n = 33) | 1 secondary hemorrhage in low-dose group; 5 secondary hemorrhages in standard-dose group | NR |
| Oral vs. topical aminocaproic acid | ||||
| Crouch 1997 | Blood filling < ⅓ of anterior chamber | 44/64 (69%) participants | NR | NR |
| Blood filling ⅓ to ½ of anterior chamber | 6/64 (9%) participants | |||
| Blood filling > ½ to ¾ of anterior chamber | 8/64 (13%) participants | |||
| Blood filling > ¾ to total of anterior chamber | 6/64 (9%) participants | |||
| Tranexamic acid vs. control | ||||
| Rahmani 1999 | Microscopic, but excluding patients with unlayered microscopic hyphemas | 17/238 (7%) participants; 6/80 (7%) in aminocaproic acid group; 4/78 (5%) in prednisolone group; 7/80 (9%) in placebo group | 2/43 (5%) secondary hemorrhages | NR |
| Blood filling < ¼ of anterior chamber | 173/238 (72%) participants; 56/80 (70%) in aminocaproic acid group; 61/78 (78%) in prednisolone group; 56/80 (70%) in placebo group | 30/43 (70%) secondary hemorrhages | ||
| Blood filling ¼ to ½ of anterior chamber | 36/238 (15%) participants; 13/80 (16%) in aminocaproic acid group; 10/78 (13%) in prednisolone group; 13/80 (16%) in placebo group | 7/43 (16%) secondary hemorrhages | ||
| Blood filling >½ of anterior chamber; excluded total hyphemas | 12/238 (5%) participants; 5/80 (6%) in aminocaproic acid group; 3/78 (4%) in prednisolone group; 4/80 (5%) in placebo group | 4/43 (9%) secondary hemorrhages | ||
| Sukumaran 1988 | Hyphema height of 0–1 mm | 8/35 (23%) participants; 4/17 (24%) in drug group; 4/18 (22%) in control group | NR | NR |
| Hyphema height of 2–3 mm | 12/35 (34%) participants; 6/17 (35%) in drug group; 6/18 (33%) in control group | |||
| Hyphema height of 4–5 mm | 10/35 (29%) participants; 5/17 (29%) in drug group; 5/18 (28%) in control group | |||
| Hyphema height of 6–7 mm | 5/35 (14%) participants; 2/17 (12%) in drug group; 3/18 (17%) in control group | |||
| Vangsted 1983 | Hyphema height of 1 mm | 10/112 (9%) participants; 8/59 (14%) in drug group; 2/53 (4%) in control group | NR | NR |
| Hyphema height of 2 mm | 33/112 (29%) participants; 15/59 (25%) in drug group; 18/53 (34%) in control group | |||
| Hyphema height of 3 mm | 37/112 (33%) participants; 18/59 (31%) in drug group; 19/53 (36%) in control group | |||
| Hyphema height of 4 mm | 18/112 (16%) participants; 9/59 (15%) in drug group; 9/53 (17%) in control group | |||
| Hyphema height of 5 mm | 9/112 (8%) participants; 6/59 (10%) in drug group; 3/53 (6%) in control group | |||
| Hyphema height of 6 mm | 4/112 (4%) participants; 3/59 (5%) in drug group; 1/53 (2%) in control group | |||
| Hyphema height of 7 mm | None in either group | |||
| Hyphema height of 8 mm | 1/112 (1%) participants; 0/59 (0%) in drug group; 1/53 (2%) in control group | |||
| Varnek 1980 | Mean hyphema height in mm | 2.0 mm in drug group (n = 102); 2.1 mm in control group (n = 130) | 1.0 mm in 2 participants in drug group with a secondary hemorrhage; 2.2 mm in 12 participants in control group with a secondary hemorrhage | NR |
| Welsh 1983 | Mean of proportion of anterior chamber area filled with blood | 68% in drug group (n = 19); 63% in placebo group (n = 20) | NR | NR |
| Aminomethylbenzoic acid vs. control | ||||
| Liu 2002 | Blood filling < ⅓ of anterior chamber and level is lower than the inferior boarder of pupil | 47/92 (51%) participants; 31/60 (52%) in drug group; 16/32 (50%) in control group | NR | NR |
| Blood filling ½ of anterior chamber and level is higher than the inferior border of the pupil, but not exceeding the median line | 30/92 (33%) participants; 19/60 (32%) in drug group; 11/32 (34%) in control group | |||
| Blood filling > ½ of anterior chamber or filling the entire anterior chamber | 15/92 (16%) participants; 10/60 (17%) in drug group; 5/32 (16%) in control group | |||
| Oral corticosteroids vs. control | ||||
| Spoor 1980 | 0–33% of anterior chamber area filled with blood | 38/43 (88%) participants; 21/23 (91%) in prednisone group; 17/20 (85%) in placebo group | 2/4 (50%) secondary hemorrhages |
|
| > 33% to 75% of anterior chamber filled with blood | 5/43 (12%) participants; 2/23 (9%) in prednisone group; 3/20 (15%) in placebo group | 2/4 (50%) secondary hemorrhages |
|
|
| Rahmani 1999 | See above under “Tranexamic acid vs. control” | |||
| Topical corticosteroids | ||||
| Zetterstrom 1969 | Mean hyphema height in mm | 2.5 mm in topical corticosteroid group (n = 58); 3.5 mm in control group (n = 59) | No patient with secondary hemorrhage in topical corticosteroid group; 4 patients with secondary hemorrhage in control group | NR |
| Antifibrinolytics vs. oral corticosteroids | ||||
| Farber 1991 | Microscopic | 24/112 (21%) participants; 11/56 (20%) in aminocaproic acid group; 13/56 (23%) in prednisone group, | 3/8 (38%) secondary hemorrhages; 2 in aminocaproic acid group; 1 in prednisone group | NR |
| Hyphema height 0.1–3.9 mm | 80/112 (71%) participants; 41/56 (73%) in aminocaproic acid group; 39/56 (70%) in prednisone group | 4/8 (50%) secondary hemorrhages; 1 in aminocaproic acid group; 3 in prednisone group | ||
| Hyphema height 4.0–5.9 mm | 4/112 (4%) participants; 3/56 (6%) in aminocaproic acid group; 1/56 (2%) in prednisone group | No secondary hemorrhages in either group | ||
| Hyphema height 6.0–11 mm | 2/112 (2%) participants; 0/56 (0%) in aminocaproic acid group; 2/56 (4%) in prednisone group | No secondary hemorrhages in either group | ||
| Total hyphema | 2/112 (2%) participants; 1/56 (2%) in aminocaproic acid group; 1/56 (2%) in prednisone group | 1/8 (12%) secondary hemorrhage; 1 in aminocaproic acid group; none in prednisone group | ||
| Rahmani 1999 | See above under “Tranexamic acid vs. control” | |||
| Conjugated estrogens vs. control | ||||
| Spaeth 1966 | Blood filling < 20% of anterior chamber | 55/85 (65%) participants; 28/39 (72%) in estrogen group; 27/46 (59%) in control group | 13/20 (65%) secondary hemorrhages; 8 in estrogen group; 5 in control group | NR |
| Blood filling 20–40% of anterior chamber | 17/85 (20%) participants; 5/39 (13%) in estrogen group; 12/46 (26%) in control group | 4/20 (20%) secondary hemorrhages; 1 in estrogen group; 3 in control group | ||
| Blood filling 40–60% of anterior chamber | 5/85 (6%) participants; 2/39 (5%) in estrogen group; 3/46 (7%) in control group | 1/20 (5%) secondary hemorrhage; 0 in estrogen group; 1 in control group | ||
| Blood filling 60–80% of anterior chamber | 2/85 (2%) participants; 1/39 (3%) in estrogen group; 1/46 (2%) in control group | No secondary hemorrhages in either group | ||
| Blood filling > 80% of anterior chamber | 6/85 (7%) participants; 3/39 (8%) in estrogen group; 3/46 (7%) in control group | 2/20 (10%) secondary hemorrhages; 1 in estrogen group; 1 in control group | ||
| Cycloplegics vs. miotics | ||||
| Bedrossian 1974 | Hyphema height of 1 mm | 20/58 (34%) participants; 10/28 (36%) in the cycloplegic group; 10/30 (33%) in the miotic group | 1/1 (100%) secondary hemorrhage (in cycloplegic group) | Mean time to resolution in cycloplegic group of 1. 9 days (SD 1.4); mean time to resolution in miotic group of 2.5 days (SD 1) |
| Hyphema height of 2 mm | 22/58 (38%) participants; 10/28 (36%) in the cycloplegic group; 12/30 (40%) in the miotic group | No secondary hemorrhages in either group | Mean time to resolution in cycloplegic group of 3. 3 days (SD 1.8); mean time to resolution in miotic group of 4.2 days (SD 1.3) | |
| Hyphema height of 3 mm | 12/58 (21%) participants; 6/28 (21%) in the cycloplegic group; 6/30 (20%) in the miotic group | No secondary hemorrhages in either group | Mean time to resolution in cycloplegic group of 3. 2 days (SD 1.9); mean time to resolution in miotic group of 4.0 days (SD 1.1) | |
| Hyphema height of 4 mm | 4/58 (7%) participants; 2/28 (7%) in the cycloplegic group; 2/30 (7%) in the miotic group | No secondary hemorrhages in either group | Mean time to resolution in cycloplegic group of 2. 5 days (1 resolved on day 2 and 1 on day 3); mean time to resolution in miotic group of 4.0 days (1 resolved on day 3 and 1 on day 5) | |
| Aspirin vs. no aspirin | ||||
| Marcus 1988 | Reported that “the two groups were comparable with respect to age, cause, and extent of hyphema” and that 2 of 3 eyes with a secondary hemorrhage in the aspirin group (n = 23) had an initial total hyphema, while of the 2 eyes with a secondary hemorrhage in the control group (n = 28), 1 had 30% and 1 had almost total hyphema | NR | ||
| Traditional Chinese medicine vs. control treatment | ||||
| Wang 1994 | Any level | No significant differences between groups | NR | Proportion of patients who were “cured” (defined as the resolution of the primary hemorrhage after 5 days of treatment, visual acuity of 0.7 or better after resolution of the primary hemorrhage, and no recurrence of bleeding for 1 week following resolution of the primary hemorrhage) was 29/45 (64%) in the TCM group and 10/38 (26%) in the control group |
| Monocular vs. binocular patching | ||||
| Edwards 1973 | Blood filling < ⅓ of anterior chamber | 42/64 (66%) participants; 21/35 (60%) in the monocular patching group; 21/29 (72%) in the binocular patching group | 7/14 (50%) secondary hemorrhages; 4 in the monocular group; 3 in the binocular group | 62% (13/21) of patients with final visual acuity of 20/50 or better in the monocular group; 71% (15/21) of patients with final visual acuity of 20/50 or better in the binocular group |
| Blood filling ⅓ to ½ of anterior chamber | 14/64 (22%) participants; 9/35 (26%) in the monocular patching group; 5/29 (17%) in the binocular patching group | 7/14 (50%) secondary hemorrhages; 4 in the monocular group; 3 in the binocular group | 57% (8/14) of patients with final visual acuity of 20/50 or better in the monocular group; 62% (5/8) of patients with final visual acuity of 20/50 or better in the binocular group | |
| Blood filling ½ or more of anterior chamber | 8/64 (12%) participants; 5/35 (14%) in the monocular patching group; 3/29 (10%) in the binocular patching group | |||
| Ambulatory vs. conservative treatment | ||||
| Read 1974 | Blood filling < ⅓ of anterior chamber | 79/137 (58%) participants; 47/71 (66%) in the ambulatory group; 32/66 (48%) in the conservative group | 16/30 (53%) secondary hemorrhages; 9 in the ambulatory group; 7 in the conservative group | NR |
| Blood filling ⅓ to ½ of anterior chamber | 28/137 (20%) participants; 11/71 (16%) patients in the ambulatory group; 17/66 (26%) patients in the conservative group | 5/30 (17%) secondary hemorrhages; 4 in the ambulatory group; 1 in the conservative group | ||
| Blood filling ½ but not total anterior chamber | 19/137 (14%) participants; 8/71 (11%) patients in the ambulatory group; 11/66 (17%) patients in the conservative group | 6/30 (20%) secondary hemorrhages; 3 in the ambulatory group; 3 in the conservative group | ||
| Total hyphema | 11/137 (8%) participants; 5/71 (7%) patients in the ambulatory group; 6/66 (9%) patients in the conservative group | 3/30 (10%) secondary hemorrhages; 2 in the ambulatory group; 1 in the conservative group | ||
| Elevation of head vs. laying flat | ||||
| Zi 1999 | Blood filling < ½ of anterior chamber and level was lower than the inferior boarder of pupil | 36/74 (49%) participants; 18/35 (51%) patients with elevation of the head; 18/39 (46%) patients laying flat | NR | NR |
| Blood filling ½ of anterior chamber and level was higher than the inferior border of the pupil | 19/74 (26%) participants; 6/35 (17%) patients with elevation of the head; 13/39 (33%) patients laying flat | NR | NR | |
| Blood filling > ½ of anterior chamber or filling the entire anterior chamber | 19/74 (26%) participants; 11/35 (31%) patients with elevation of the head; 8/39 (21%) patients laying flat | NR | NR | |
| Other | ||||
| Rakusin 1972 * | Blood filling < ½ of anterior chamber | 213 participants | NR |
|
| Blood filling > ½ of anterior chamber | 157 participants | NR |
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|
*
Rakusin 1972 reported severity for entire study population rather than by trials of topical corticosteroids, cycloplegics vs. miotics, monocular vs. binocular patching, and ambulatory vs. conservative treatment. See under “Other”.
CI: confidence interval; n: number of participants; NR: not reported; RR: risk ratio; SD: standard deviation; SE: standard error.