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Citations 0
November 2001

Risk Factors for Complications Following Traumatic Hyphema

Arch Ophthalmol. 2001;119(11):1732. doi:

We strongly support the article by Lai et al1 in which the authors found African American children to be at higher risk for developing a rebleed following a traumatic hyphema. They also found that sickle cell hemoglobinopathy increased the risk of intraocular pressure elevation but did not appear to increase the risk of secondary hemorrhage.

We have made similar observations at the University of Illinois Eye and Ear Infirmary (Chicago). Even in the absence of hemoglobinopathies, the course of hyphemas is prolonged and the incidence of rebleeding is higher in African American patients. We hypothesized that this susceptibility might be partly related to the release of melanin into the anterior chamber during ocular trauma. This hypothesis was supported by our study in which we examined the effects of melanin in a rabbit model of laser-induced hyphema.2 We demonstrated that the placement of melanin in the anterior chamber resulted in a significantly prolonged course of hyphema. During a histologic examination, a greater inflammatory response was observed in the anterior chamber and trabecular meshwork in the melanin-treated eyes than in the control eyes. Occlusion of the trabecular meshwork by melanin-laden macrophages and other inflammatory cells was proposed as one of the mechanisms responsible for the prolonged course of hyphema.

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