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September 1997

The Treatment of Traumatic Hyphema With Topical ε-Aminocaproic Acid

Author Affiliations

Baltimore, Md

Arch Ophthalmol. 1997;115(9):1189-1190. doi:10.1001/archopht.1997.01100160359016

The HOLY Grail in treatment of traumatic hyphema has been reduction in the rate of recurrent bleeding ("secondary hemorrhage"). Ample evidence exists that secondary hemorrhage is associated with a worsened visual prognosis in comparison with eyes not sustaining such events.1,2 The cause of the reduced vision is frequently multifactorial; often, however, it can be directly attributable to the extra bleeding itself, because the induced glaucoma causes optic atrophy or corneal blood staining. In most therapeutic trials for traumatic hyphema, therefore, the key end-point variable has been the rate of secondary hemorrhage. During the past 20 years, several trials3-6 have shown that this rate can be significantly reduced by use of a systemic (oral) antifibrinolytic agent, usually ε-aminocaproic acid (Amicar) or tranexamic acid. Topical and systemic corticosteroids have also had their proponents7-9 and their detractors.10

Although several clinical trials with Amicar have shown a reduction in the

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