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Original article
Traumatic hyphaema in children: a retrospective and prospective study of outcomes at an Australian paediatric centre
  1. Michael D Richards1,2,
  2. Kate Barnes1,2,
  3. Anne-Marie E Yardley1,2,
  4. Kate Hanman1,2,
  5. Geoffrey C Lam2,3,
  6. David A Mackey1,3
  1. 1 Lions Eye Institute, Perth, Western Australia, Australia
  2. 2 Department of Ophthalmology, Perth Children’s Hospital, Perth, Western Australia, Australia
  3. 3 Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Michael D Richards ; michaelrichards{at}lei.org.au

Abstract

Objective This study aims to evaluate the presenting characteristics, management, outcomes and complications for paediatric traumatic hyphaema in Western Australia.

Methods and Analysis A retrospective review of medical records was conducted for consecutive patients ≤16 years of age admitted for traumatic hyphaema to Princess Margaret Hospital for Children (Perth, Australia) between January 2002 and December 2013 (n=82). From this sample, a cohort whose injury occurred ≥5 years prior attended a prospective ocular examination (n=16). Hospital records were reviewed for patient demographics, injury details, management, visual outcomes and complications. The prospective cohort underwent examination for visual and structural outcomes.

Results Most injuries (72%) resulted from projectile objects. Angle recession was present in 53% and was associated with projectiles (p=0.002). Most eyes (81%) achieved a final visual acuity of 0.3 logarithm of the minimum angle of resolution (logMAR) (20/40) or better. Age ≤5 years and posterior segment injury were significant predictors of final visual acuity poorer than 0.3 logMAR. At ≥5 years post-trauma, injured eyes had greater intraocular pressure (IOP) (p=0.024) and anterior chamber depth (ACD) (p=0.022) compared with sound eyes. IOP asymmetry was associated with angle recession (p=0.008) and ACD asymmetry (p=0.012).

Conclusion Poorer visual outcomes are associated with younger age at injury and posterior segment injury. Angle recession and ACD asymmetry are associated with IOP asymmetry 5–12 years after injury.

  • trauma
  • child health (paediatrics)
  • anterior chamber

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjophth-2018-000215

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    Footnotes

    • Contributors MDR conducted data analysis and wrote the manuscript. KB designed the study, collected data from medical records, performed ophthalmological examinations and reviewed the manuscript. A-MEY contributed to study design, collected data from medical records and reviewed the manuscript. KH collected data from medical records. GCL and DAM provided study supervision and reviewed the manuscript.

    • Funding This study was supported by the Joyce Henderson Bequest Fund for Children’s Eye Research, Lions Eye Institute, Perth, Australia.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study was approved by the Princess Margaret Hospital for Children Human Research Ethics Committee (HREC Ref No 2013094EP) and was conducted in accordance with the tenets of the Declaration of Helsinki. Written informed consent was obtained from all patients in the recalled cohort prior to examination.

    • Provenance and peer review Not commissioned; externally peer reviewed.