Natural History of Intraocular Pressure After Pediatric Hyphema; Implications for Surveillance

Abstract

Purpose: Pediatric patients with closed-globe injury (CGI) and traumatic hyphema are at risk for elevated intraocular pressure (IOP), which can have devastating consequences. Presently, patients are seen on a frequent but arbitrary schedule to monitor IOP. We sought to develop an evidence-based algorithm to prescribe follow-up after this injury. Methods: Billing records were used to identify all patients who presented to Boston Children's Hospital (BCH) between January 2002 and April 2019 with CGI and traumatic hyphema. The primary outcome measure was timing of IOP elevation (>21 mmHg). Secondary outcome measures were identification of risks factors for IOP elevation by logistic regression. Results: Three-hundred-and-seven patients met inclusion with 119 suffering elevated IOP. IOP elevations clustered at presentation (n=35), between day 1-7 after injury (n=69), between day 8-28 (n=35), and after day 28 (n=36). Logistic regression analysis showed pupil damage at presentation predicted elevated IOP between days 1-7 (p=0.007). Analysis of this large cohort shows that elevated IOP after hyphema occurs at various times. Patients with elevated IOP at presentation or pupil damage at presentation need careful monitoring within the first 7 days after injury; other patients do not need follow-up at <7 days after injury. Patients with angle recession as evidenced by gonioscopic exam need longer term follow up than patients without angle recession. Conclusions: These data allow us to generate an evidence-based guideline to prescribe a follow-up regimen for pediatric CGI patients with traumatic hyphema using factors known at presentation. Since there are no published guidelines on frequency of follow-up of these children, we believe that this data will improve outcomes while eliminating unnecessary visits.