Topical aminocaproic acid in the treatment of traumatic hyphema
E. R. Crouch Jr, P. B. Williams, M. K. Gray, E. R. Crouch and M. Chames
Department of Ophthalmology, Eastern Virginia Medical School, Norfolk, USA. crouch@picard.evms.edu
OBJECTIVES: To determine whether topically applied aminocaproic acid, like
systemic aminocaproic acid, effectively reduces secondary hemorrhage after
hyphemas and to compare the safety and effectiveness of topical application
with those of systemic use and a control group. DESIGN: A prospective,
randomized, double-masked, multicenter study. PATIENTS: Sixty-four patients
with traumatic hyphema treated with topical or systemic aminocaproic acid
and compared with 54 control patients with hyphema. Daily slitlamp
examinations for hyphema grading and corneal clarity, initial and final
visual acuity, applanation tonometry, and fundus indirect ophthalmoscopy
were studied. Follow-up was 6 months to 5 1/2 years (mean, 2.96 years).
RESULTS: Compared with the control group, topical and systemic aminocaproic
acid was statistically significant in preventing secondary hemorrhage. Only
3% (2/64) of the patients who received topical or systemic aminocaproic
acid had secondary hemorrhage compared with 22% (12/54) of the control
group (P = .002). Final visual acuity was 20/40 or better in 30 patients
(86%) in the topical group compared with 23 patients (43%) in the control
group (P < .001). Final visual acuity was 20/40 or better in 20 patients
(69%) in the systemic aminocaproic acid group compared with 23 patients
(43%) in the control group (P = .04). The topical aminocaproic acid group
had a final visual acuity of 20/40 or better in 86% of patients, compared
with 69% of patients in the systemic group. CONCLUSIONS: Topical
aminocaproic acid appears to be a safe, effective treatment to prevent
secondary hemorrhage in traumatic hyphema. It is as effective as systemic
aminocaproic acid in reducing secondary hemorrhage. No systemic side
effects were observed with topical use. Topical aminocaproic acid provides
an effective out-patient treatment for traumatic hyphemas.
