Cochrane · systematic review · CD005431
Medical interventions for traumatic hyphema
Woreta, FA, Lindsley, KB, Gharaibeh, A, et al. · Cochrane Database of Systematic Reviews · 2023 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
39
current version
GRADE rated
30
No studies
9
Included studies
NR
No studies 9 · 23.1%Ungraded 0 · 0%Very low 5 · 12.8%Low 22 · 56.4%Moderate 3 · 7.7%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySystemic aminocaproic acid compared with placebo for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity 20/40 or better ≤ 2 weeks after treatment Systemic aminocaproic acid vs placebo | RR 0.87 [0.57, 1.32] | 1 study · 34 participants | Low Downgraded: imprecision, indirectness |
Medium‐term visual acuity 20/40 or better > 2 weeks and ≤ 2 months after treatment Systemic aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Long‐term visual acuity 20/40 or better > 2 months after treatment Systemic aminocaproic acid vs placebo | RR 1.03 [0.82, 1.29] | 2 studies · 108 participants | Low Downgraded: imprecision, inconsistency |
Final visual acuity 20/40 or better at resolution of hyphema Systemic aminocaproic acid vs placebo | RR 1.05 [0.93, 1.18] | 2 studies · 143 participants | Low Downgraded: imprecision, indirectness |
Time to resolution of primary hemorrhage Systemic aminocaproic acid vs placebo | no estimate extracted | 6 studies · 330 participants | Low Downgraded: imprecision, indirectness |
Secondary hemorrhage at any time point Systemic aminocaproic acid vs placebo | RR 0.28 [0.13, 0.6] | 6 studies · 330 participants | Low Downgraded: inconsistency, indirectness |
Adverse effects: nausea or vomiting Systemic aminocaproic acid vs placebo | RR 8.6 [2.09, 35.5] | 3 studies · 131 participants | Moderate Downgraded: imprecision |
Topical aminocaproic acid compared with placebo for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity 20/40 or better ≤ 2 weeks after treatment Topical aminocaproic acid vs placebo | RR 0.87 [0.47, 1.6] | 1 study · 51 participants | Low Downgraded: imprecision |
Medium‐term visual acuity 20/40 or better > 2 weeks and ≤ 2 months after treatment Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Long‐term visual acuity 20/40 or better > 2 months after treatment Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Final visual acuity 20/40 or better at resolution of hyphema Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Time to resolution of primary hemorrhage Topical aminocaproic acid vs placebo | no estimate extracted | 2 studies · 142 participants | Low Downgraded: inconsistency, indirectness |
Secondary hemorrhage at any time point Topical aminocaproic acid vs placebo | RR 0.48 [0.2, 1.1] | 2 studies · 131 participants | Low Downgraded: imprecision, indirectness |
Adverse effects: systemic hypotension Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Systemic tranexamic acid compared with control for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity 20/40 or better ≤ 2 weeks after treatment Systemic tranexamic acid vs control | RR 1.12 [1, 1.25] | 4 studies · 425 participants | Moderate Downgraded: risk of bias |
Medium‐term visual acuity 20/40 or better > 2 weeks and ≤ 2 months after treatment Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Long‐term visual acuity 20/40 or better > 2 months after treatment Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Final visual acuity 20/40 or better at resolution of hyphema Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Time to resolution of primary hemorrhage Systemic tranexamic acid vs control | no estimate extracted | 5 studies · 549 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Secondary hemorrhage at any time point Systemic tranexamic acid vs control | RR 0.33 [0.21, 0.53] | 7 studies · 754 participants | Low Downgraded: risk of bias, indirectness |
Adverse effects: nausea Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Systemic or topical corticosteroids compared with placebo or control treatment for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity between 20/20 and 20/40 ≤ 2 weeks after treatment; oral corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | RR 1.2 [0.97, 1.49] | 2 studies · 277 participants | Low Downgraded: imprecision, indirectness |
Final visual acuity between 20/20 and 20/40 at end of treatment; oral corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | RR 1.01 [0.84, 1.23] | 1 study · 41 participants | Low Downgraded: imprecision, indirectness |
Short‐term visual acuity between 20/20 and 20/40 ≤ 2 weeks after treatment; topical corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | RR 0.75 [0.38, 1.47] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Final visual acuity between 20/20 and 20/25 at end of treatment; topical corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | RR 1.02 [0.94, 1.11] | 1 study · 111 participants | Low Downgraded: risk of bias, imprecision |
Time to resolution of primary hemorrhage; oral corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | no estimate extracted | 2 studies · 166 participants | Low Downgraded: imprecision, indirectness |
Time to resolution of primary hemorrhage; topical corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | no estimate extracted | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Risk of secondary hemorrhage; oral corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | RR 0.63 [0.4, 0.97] | 3 studies · 323 participants | Low Downgraded: imprecision, indirectness |
Risk of secondary hemorrhage; topical corticosteroids Systemic or topical corticosteroids vs placebo or control treatment | RR 0.29 [0.05, 1.53] | 2 studies · 151 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Other pharmaceutical agents compared with placebo or other control interventions for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity between 20/20 and 20/60 at end of treatment; cycloplegics vs miotics Other pharmaceutical agents vs placebo or other control interventions | RR 0.82 [0.46, 1.45] | 1 study · 34 participants | Low Downgraded: risk of bias, imprecision |
Risk of secondary hemorrhage; conjugated estrogen Other pharmaceutical agents vs placebo or other control interventions | RR 1.18 [0.55, 2.54] | 1 study · 85 participants | Moderate Downgraded: imprecision |
Risk of secondary hemorrhage; cycloplegics Other pharmaceutical agents vs placebo or other control interventions | RR 1.03 [0.15, 6.99] | 2 studies · 92 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Risk of secondary hemorrhage; aspirin Other pharmaceutical agents vs placebo or other control interventions | RR 1.83 [0.33, 10.02] | 1 study · 51 participants | Low Downgraded: risk of bias, imprecision |
Non‐pharmaceutical interventions compared with control for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity between 20/20 and 20/60 at end of treatment; monocular vs binocular eye patching Non‐pharmaceutical interventions vs control | RR 0.82 [0.67, 1] | 1 study · 46 participants | Low Downgraded: risk of bias, imprecision |
Final visual acuity between 20/20 and 20/50; monocular vs binocular eye patching Non‐pharmaceutical interventions vs control | RR 0.95 [0.77, 1.18] | 1 study · 53 participants | Low Downgraded: risk of bias, imprecision |
Short‐term visual acuity between 20/20 and 20/50 at end of treatment; ambulatory vs bed rest Non‐pharmaceutical interventions vs control | RR 1.1 [0.84, 1.44] | 1 study · 52 participants | Low Downgraded: risk of bias, imprecision |
Time to resolution of primary hemorrhage; ambulatory vs bed rest Non‐pharmaceutical interventions vs control | no estimate extracted | 1 study · 137 participants | Low Downgraded: risk of bias, imprecision |
Risk of secondary hemorrhage; monocular vs binocular eye patching Non‐pharmaceutical interventions vs control | RR 0.77 [0.35, 1.72] | 2 studies · 117 participants | Low Downgraded: risk of bias, imprecision |
Risk of secondary hemorrhage; ambulatory treatment vs bed rest Non‐pharmaceutical interventions vs control | RR 1.28 [0.68, 2.4] | 2 studies · 189 participants | Low Downgraded: imprecision, inconsistency |
Systemic aminocaproic acid compared with placebo for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity 20/40 or better ≤ 2 weeks after treatment Systemic aminocaproic acid vs placebo | RR 0.87 [0.57, 1.32] | 1 study · 34 participants | Low Downgraded: imprecision, indirectness |
Medium‐term visual acuity 20/40 or better > 2 weeks and ≤ 2 months after treatment Systemic aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Long‐term visual acuity 20/40 or better > 2 months after treatment Systemic aminocaproic acid vs placebo | RR 1.03 [0.82, 1.29] | 2 studies · 108 participants | Low Downgraded: imprecision, inconsistency |
Final visual acuity 20/40 or better at resolution of hyphema Systemic aminocaproic acid vs placebo | RR 1.05 [0.93, 1.18] | 2 studies · 143 participants | Low Downgraded: imprecision, indirectness |
Time to resolution of primary hemorrhage Systemic aminocaproic acid vs placebo | no estimate extracted | 6 studies · 330 participants | Low Downgraded: imprecision, indirectness |
Secondary hemorrhage at any time point Systemic aminocaproic acid vs placebo | RR 0.28 [0.13, 0.6] | 6 studies · 330 participants | Low Downgraded: inconsistency, indirectness |
Adverse effects: nausea or vomiting Systemic aminocaproic acid vs placebo | RR 8.6 [2.09, 35.5] | 3 studies · 131 participants | Moderate Downgraded: imprecision |
Topical aminocaproic acid compared with placebo for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity 20/40 or better ≤ 2 weeks after treatment Topical aminocaproic acid vs placebo | RR 0.87 [0.47, 1.6] | 1 study · 51 participants | Low Downgraded: imprecision |
Medium‐term visual acuity 20/40 or better > 2 weeks and ≤ 2 months after treatment Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Long‐term visual acuity 20/40 or better > 2 months after treatment Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Final visual acuity 20/40 or better at resolution of hyphema Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Time to resolution of primary hemorrhage Topical aminocaproic acid vs placebo | no estimate extracted | 2 studies · 142 participants | Low Downgraded: inconsistency, indirectness |
Secondary hemorrhage at any time point Topical aminocaproic acid vs placebo | RR 0.48 [0.2, 1.1] | 2 studies · 131 participants | Low Downgraded: imprecision, indirectness |
Adverse effects: systemic hypotension Topical aminocaproic acid vs placebo | no estimate extracted | NR | No studies |
Systemic tranexamic acid compared with control for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity 20/40 or better ≤ 2 weeks after treatment Systemic tranexamic acid vs control | RR 1.11 [0.98, 1.25] | 3 studies · 303 participants | Low Downgraded: risk of bias, imprecision |
Medium‐term visual acuity 20/40 or better > 2 weeks and ≤ 2 months after treatment Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Long‐term visual acuity 20/40 or better > 2 months after treatment Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Final visual acuity 20/40 or better at resolution of hyphema Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Time to resolution of primary hemorrhage Systemic tranexamic acid vs control | no estimate extracted | 5 studies · 549 participants | Very low Downgraded: risk of bias, inconsistency, indirectness |
Secondary hemorrhage at any time point Systemic tranexamic acid vs control | RR 0.31 [0.17, 0.55] | 5 studies · 578 participants | Low Downgraded: risk of bias, indirectness |
Adverse effects: nausea Systemic tranexamic acid vs control | no estimate extracted | NR | No studies |
Systemic or topical corticosteroids compared with usual treatment for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity between 20/20 and 20/40 ≤ 2 weeks after treatment; oral corticosteroids Systemic or topical corticosteroids vs usual treatment | RR 1.22 [0.88, 1.99] | 1 study · 155 participants | Low Downgraded: imprecision, indirectness |
Final visual acuity between 20/20 and 20/40 at end of treatment; oral corticosteroids Systemic or topical corticosteroids vs usual treatment | RR 1.01 [0.84, 1.23] | 1 study · 41 participants | Low Downgraded: imprecision, indirectness |
Short‐term visual acuity between 20/20 and 20/40 ≤ 2 weeks after treatment; topical corticosteroids Systemic or topical corticosteroids vs usual treatment | RR 0.75 [0.38, 1.47] | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Final visual acuity between 20/20 and 20/25 at end of treatment; topical corticosteroids Systemic or topical corticosteroids vs usual treatment | RR 1.02 [0.94, 1.11] | 1 study · 111 participants | Low Downgraded: risk of bias, imprecision |
Time to resolution of primary hemorrhage; oral corticosteroids Systemic or topical corticosteroids vs usual treatment | no estimate extracted | 2 studies · 166 participants | Low Downgraded: imprecision, indirectness |
Time to resolution of primary hemorrhage; topical corticosteroids Systemic or topical corticosteroids vs usual treatment | no estimate extracted | 1 study · 34 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Risk of secondary hemorrhage; oral corticosteroids Systemic or topical corticosteroids vs usual treatment | RR 0.68 [0.39, 1.18] | 2 studies · 201 participants | Low Downgraded: imprecision, indirectness |
Risk of secondary hemorrhage; topical corticosteroids Systemic or topical corticosteroids vs usual treatment | RR 0.29 [0.05, 1.53] | 2 studies · 151 participants | Very low Downgraded: risk of bias, imprecision, indirectness |
Other pharmaceutical agents compared with placebo or other control interventions for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity between 20/20 and 20/60 at end of treatment; cycloplegics versus miotics Other pharmaceutical agents vs placebo or other control interventions | RR 0.82 [0.46, 1.45] | 1 study · 34 participants | Low Downgraded: risk of bias, imprecision |
Risk of secondary hemorrhage; conjugated estrogen Other pharmaceutical agents vs placebo or other control interventions | RR 1.18 [0.55, 2.54] | 1 study · 85 participants | Moderate Downgraded: imprecision |
Risk of secondary hemorrhage; cycloplegics Other pharmaceutical agents vs placebo or other control interventions | RR 1.03 [0.15, 6.99] | 2 studies · 92 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Risk of secondary hemorrhage; aspirin Other pharmaceutical agents vs placebo or other control interventions | RR 1.83 [0.33, 10.02] | 1 study · 51 participants | Low Downgraded: risk of bias, imprecision |
Non‐pharmaceutical interventions compared with usual care for traumatic hyphema
Population: people with traumatic hyphema
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Short‐term visual acuity between 20/20 and 20/60 at end of treatment; monocular versus binocular eye patching Non‐pharmaceutical interventions vs usual care | RR 0.82 [0.67, 1] | 1 study · 46 participants | Low Downgraded: risk of bias, imprecision |
Final visual acuity between 20/20 and 20/50; monocular versus binocular eye patching Non‐pharmaceutical interventions vs usual care | RR 0.95 [0.77, 1.18] | 1 study · 53 participants | Low Downgraded: risk of bias, imprecision |
Short‐term visual acuity between 20/20 and 20/50 at end of treatment; ambulatory versus bed rest Non‐pharmaceutical interventions vs usual care | RR 1.1 [0.84, 1.44] | 1 study · 52 participants | Low Downgraded: risk of bias, imprecision |
Time to resolution of primary hemorrhage; ambulatory versus bed rest Non‐pharmaceutical interventions vs usual care | no estimate extracted | 1 study · 137 participants | Low Downgraded: risk of bias, imprecision |
Risk of secondary hemorrhage; monocular versus binocular eye patching Non‐pharmaceutical interventions vs usual care | RR 0.77 [0.35, 1.72] | 2 studies · 117 participants | Low Downgraded: risk of bias, imprecision |
Risk of secondary hemorrhage; ambulatory treatment versus bed rest Non‐pharmaceutical interventions vs usual care | RR 1.28 [0.68, 2.4] | 2 studies · 189 participants | Low Downgraded: imprecision, inconsistency |