Travmatik Hifemada Klinik ve Görsel Prognoza Etki Eden Faktörler

Year 2023, Volume: 13 Issue: 2, 204 - 209, 30.06.2023

Özlem Bursalı , Emine Doğan , Nilgün Özkan , Şule Bahadır Coşkun , Erkan Çelik , Gürsoy Alagöz

https://doi.org/10.31832/smj.1162452

Abstract

Amaç: Travmatik hifema nedeniyle takip edilen olgularda demografik ve klinik özelliklerin incelenmesi ve görsel prognoza etki eden faktörlerin değerlendirilmesi
Gereç -Yöntem: Travmatik hifema tanısıyla takip edilen 48 hastanın dosyaları geriye dönük olarak taranarak; yaş, cinsiyet, yaralanma nedeni, hifema düzeyi, başlangıç en iyi düzeltilmiş görme keskinliği (EİDGK), eşlik eden klinik bulgular, son muayenedeki EİDGK incelendi. EİDGK’ne etki eden prognostik faktörler incelendi.
Bulgular: Hastaların (38 erkek,10 kadın) yaş ortalaması 39.5±21.6 yıl olup; en sık travma nedeni odun çarpmasına bağlı künt travma (%25) idi. Hifema düzeyi değerlendirildiğinde en sık Evre 1(%41.66) hifema mevcuttu. Travmaya eşlik eden bulgular; 23 gözde (%47.91) kornea epitel defekti,11 gözde (%22.91) iridodiyaliz, 7 gözde (%14,58) fakodonezis,10 gözde (%20.83) vitreus hemorajisi idi. Başvuru anında 35 gözde göz içi basıncı (GİB) yüksek olup medikal tedavi ile kontrol altına alındı, 3 gözde ön kamara lavajı yapılması gerekti. Hastaların başlangıç,1.hafta ve 3.ay EİDGK sırasıyla 1.7 ±0.8; 0.5±0.5; 0.2±0.3 (LogMAR )idi. Hastaların 4’üne ek cerrahi işlem (lens ekstraksiyonu + göz içi mercek implantasyonu ve/veya vitreoretinal cerrahi) gerekti. İridodiyaliz (p=0,023 r= -0,345), fakodonezis (p=0,020,r= -0,347) ve vitreus hemorajisi (p=0,000, r= -0,553) varlığı ile son görme düzeyi arasında negatif korelasyon mevcuttu.
Tartışma: Travmatik hifemaya sıklıkla çeşitli ön- arka segment bulguları eşlik etmekte olup; iridodiyaliz, fakodonezis ve vitreus hemorajisi varlığı görme prognozunu olumsuz etkilemektedir.

Keywords

Göz travması;, hifema, komplikasyon, görme prognozu

Traumatic Hyphema: Factors Affecting Clinical and Visual Prognosis

Abstract

Objective: To examine the clinical features and evaluate the factors affecting the visual prognosis in traumatic hyphema.
Materials and Methods: The files of 48 patients followed up with the diagnosis of traumatic hyphema were analyzed retrospectively. Age, gender, cause of injury, grade of hyphema, initial visual acuity, accompanying clinical findings, and best corrected visual acuity (BCVA) at the last examination were examined. Prognostic factors affecting BCVA were examined.
Results: The mean age of the patients (thirty-eight males, ten females) was 39.5±21.6 years. The most common cause of trauma was blunt trauma (25%) by a piece of wood. The most commonly seen grade was Grade I (41.7%). The corneal epithelial defect was noted in 23 eyes (47.91%), iridodialysis in 11 eyes (22.91%), phacodonesis in 7 eyes (14.58%), and vitreous hemorrhage in 10 eyes (20.83%). At the initial examination, elevated intraocular pressure (IOP) was detected in 35 eyes and controlled with medical treatment. Anterior chamber irrigation was performed in 3 eyes. The BCVA of the patients at baseline, week 1, and month 3 were 1.7 ± 0.8, respectively; 0.5±0.5; was 0.2±0.3 (LogMAR). Additional surgical procedures (lens extraction and intraocular lens implantation with or without vitreoretinal surgery) were performed on 4 patients. There was a negative correlation between the presence of iridodialysis (p=0.023 r= -0.345), phacodonesis (p=0.020,r= -0.347), and vitreous hemorrhage (p=0.000, r= -0.553) and final BCVA.
Conclusion: Traumatic hyphema is often accompanied by various anterior-posterior segment findings. The presence of iridodialysis, phacodonesis, and vitreous hemorrhage affects the visual prognosis negatively.

Keywords

eye injuries, hyphema, complications, visual prognosis

References

• Referans1.Galvis V, Pedraza-Concha A, Tello A, Plata ML, Escaf CL, Berrospi DR. Clinical features, management and visual outcomes on patients with traumatic hyphema in a reference ophthalmological clinic in Colombia. Rom J Ophthalmol. 2020 Jan-Mar;64(1):28-34.
• Referans2.Türkoğlu EB, Celik T, Celik E, Ozkan N, Bursalı O, Coşkun S.B et al. Is topical corticosteroid necessary in traumatic hyphema?. J Fr Ophtalmol. 2014; 37:613– 7.
• Referans3.Edward WC, Layden WE. Traumatic hyphema. A report of 184 consecutive cases. Am J Ophthalmology 1973; 110-116
• Referans4. Zafar S, Canner JK, Mir T, Srikumaran D, Channa R, Goldberg MF et al.Epidemiology of Hyphema-Related Emergency Department Visits in The United States Between 2006 and 2015. Ophthalmic Epidemiol. 2019 Jun;26(3):208-215.
• Referans5. Baker RS, Wilson RM, Flowers CW Jr, Lee DA, Wheeler NC. A population-based survey of hospitalized work-related ocular injury: diagnoses, cause of injury, resource utilization, and hospitalization outcome. Ophthalmic Epidemiol. 1999 Sep;6(3):159-69.
• Referans6.Chen EJ, Fasiuddin A. Management of Traumatic Hyphema and Prevention of Its Complications. Cureus. 2021 Jun 20;13(6):e15771.
• Referans7.Wang W, Zhou Y, Zeng J, Shi M, Chen B. Epidemiology and clinical characteristics of patients hospitalized for ocular trauma in South-Central China. Acta Ophthalmol. 2017 Sep;95(6):e503-e510.
• Referans8.Cheung CA, Rogers-Martel M, Golas L, Chepurny A, Martel JB et al.Hospital-based ocular emergencies: epidemiology, treatment, and visual outcomes. Am J Emerg Med. 2014 Mar;32(3):221-4.
• Referans9.Kızıloğlu M, Kızıloğlu TG, Yalnız Akkaya Z, Burcu A, Örnek F. Künt göz travmalarında prognostik faktörler. Turk J Ophthalmol 2013;43(1):32-8.
• Referans10.Uhumwangho OM, Umolo OC. Traumatic hyphema in Benin City, Nigeria. Sahel Med J 2014;17:128 31.
• Referans11. Ashaye AO. Traumatic hyphaema: a report of 472 consecutive cases. BMC Ophthalmol. 2008 Nov 26;8:24.
• Referans12. S Simanjuntak GW, Farinthska G, M Simanjuntak GA, Artini W, Natali R. Risk factors for poor visual outcome in traumatic hyphema: Jakarta eye trauma study. Niger J Clin Pract. 2018 Jul;21(7):921-924.
• Referans13. Boriçi K, Çorum I,Özgün C. Künt Travmaya Bagl› Hifemada Klinik Özellikler: 590 Hasta.; T. Oft. Gaz. 2008;38:250-255
• Referans14.Toptan M, Şimşek A, Göz içi basıncı yüksk olan hifemalı hastalarda tedavi ve prognoz. ADYÜSağlık Bilimleri Derg.2020;6(1):93-99
• Referans15.Çağlar Ç, Çinal A, Yaşar T, Demirok A. Künt oküler travmaya bağlı oluşan hifemalarda klinik özellikler. Ege Tıp Dergisi. 2009;48:(2), 95 – 99
• Referans16.Yılmaz A, Özgün C, Yıldırım A et al. Treatment and prognosis in the traumatic hyphema.Ulus Travma Ail Cerrahi Derg.1996;2(1):75-80
• Referans17. Gharaibeh A, Savage HI, Scherer RW, Goldberg MF, Lindsley K. Medical interventions for traumatic hyphema. Cochrane Database Syst Rev. 2019 Jan 14;1(1):CD005431.
• Referans18.Jahadi Hosseini SH, Khalili MR, Motallebi M. Comparison between topical and oral tranexamic acid in management of traumatic hyphema. Iran J Med Sci 2014;39:178-83.
• Referans19. Odarosa M. Uhumwangho, Onoriode C. Umolo. Traumatic hyphema in Benin City, Nigeria.Sahel Medical Journal.2014;17:(4):128-131
• Referans20. Mowatt L, Chambers C. Ocular morbidity of traumatic hyphema in a Jamaican hospital. Eur J Ophthalmol. 2010 May-Jun;20(3):584-9.