A retrospective study of incidence of hyphemain tertiary care teaching hospital, South Kerala

Objective: In current this study, aims to assess hyphema involving of eye presented to Emergency medicine department and Ophthalmology outpatient department at PIMS&RC, tertiary care hospital in Thiruvalla, south Kerala State, India.689001. Materials and Methods: This study was conducted at the Department of Ophthalmology and Emergency Medicine Department retrospective study, over a period of two years from May 2022 and May 2024. The medical records of all patients who attended emergency department and outpatient department were retrospectively reviewed. All patients were seen by trained emergency duty doctors, ophthalmologists, resident’s doctors. Patients with attending the Emergency department and the Ophthalmology department were included in the study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The data collected data from medical record department and electronic patient record (EPR). The descriptive and analytic statistics were carried out. Purpose: The study aims to assess the hyphema involving anterior segment of eye presented at emergency department and ophthalmology outpatient department at PIMS&RC, Thiruvalla, Kerala State, and India. Materials and Methods: Retrospective study was conducted at the Department of Ophthalmology and Emergency Medicine Department between May 2022 and May 2024. The records of 108 eyes of 194 patients with a diagnosis of hyphema were retrospectively reviewed from electronic patient record (EPR). The medical records of all patients who attended emergency department and outpatient department were retrospectively reviewed. All patients were seen by trained emergency duty doctors, ophthalmologists, resident’s doctors. Patients with hyphema attending the Emergency department and the Ophthalmology department were included in this study after applying the inclusion and exclusion criteria. A detailed and comprehensive ophthalmic examination was performed and visual acuity was noted at the presentation and follow-ups. The data collected data from medical record department and electronic patient record (EPR). The descriptive and analytic statistics were carried out. Results: A total number of194 patients were participated in this study. Out of 194 patients 108 eyes were involved 104(96.3%) eyes were unilateral involvement and 4(3.70%) eyes were bilateral involvement. 108 were male patients (55.7%) and 86 were (44.3%) female patients. Patients of all age groups were considered in this study. Most vulnerable age group was 20-40 years (59.2%) followed by 26-60 years (%). Most common mode of injuries were blunt injury eyes 54(50%) followed by neovascurization of iris(NVI) 24eyes (22.2%) , postoperative hyphema 18 eyeS (16.6)and patients underwent laser peripheral iridotomy12 eyes(11%) and 3 eyes with anterior chamber intra ocular lens(ACIOL)(2.7%). In our study maximum numbers of patients were farmers. Most common mode of injuries were blunt injury followed by systemic disorders like proliferative diabetic retinopathy PDR,) central vein occlusion( CRVO )and post-operative procedures.(Table 4).In our patients we saw grade 1 hyphema in 64 eyes (59.2%) followed by grade 2 hyphema seen in 26 eyes(24%). Management of hyphema includes medical management and surgical management. Most hyphema are self- limited resolve within 5-8days with bed rest, head end elevations more than 30 degrees, eye shields. Grade 1& 2 hyphemas without high IOP, treated with topical predforte 1% eye drops and homide eye drops.Eyes with high IOP treated with anti-glaucoma medication drugs. In our study no sickle cell disease patient. Out of 194 patients4 patients underwent phacoemulsification for traumatic cataract, 6 patients anterior chamber wash(AC WASH), and 8 patients underwent trabeculectomy with mitomycin(0.2% MMC).We discontinued anticoagulants, antiplatelets , non- steroidal anti-inflammatory drugs and aspirin.In our study we have not used antifibrinolytics such as tranexamic acid and aminiocaproic acid also reduce the risk of secondary haemorrhage by promoting coagulation. Surgical management is indicated in grade 4 hyphema with IOP more than 50mmHg and corneal blood staining. Conclusion: In our study ocular trauma was more common cause for hyphema. Majority of patients were farmers. Despite our methodology, the inherent limitations of studies should be considered and conclusion drawn from our pooled results should be interpreted with caution. Future large-volume, well-designed with extensive follow-up is awaited to confirm and update the findings of this analysis.