Traumatic hyphema: a critical review of the scientifically catastrophic history of steroid treatment therefore; and A report of 24 additional cases with no rebleeding after treatment with the Yasuna systemic steroid, no touch PLUS protocol.
OBJECTIVE
To establish a detailed history of steroid therapy administered either systemically or topically for traumatic hyphema (TH) over the past 40 years. To this literature, we report and add another 24 TH cases treated with the Yasuna systemic steroid No Touch PLUS protocol.


METHODS
Review of all reports in Medline since its inception in 1966 and such reports not in Medline but retrievable by successive reference and various alternate sources. Retrospective review of charts of all cases of TH at the University of Florida from 1980-1987. Of 135 cases so retrieved, 24 were found who had received this treatment protocol properly. (Ethical, moral and liability aspects prohibited a formal comparative study of a no medical treatment control group since this is unconscionable and abusive at the present state of knowledge.)


RESULTS
The historical review revealed that there is general ignorance of the salutary effect of both topical and systemic steroids in reducing the rebleed rate in TH. This is so marked that at least five experiments reported in the literature are invalidated to a variable degree because all patients, in both the experimental and control groups, had received topical steroids. Further, that the remarkable reduction in the rebleed rates for control groups of theoretically medically untreated TH, from the vicinity of 25% or more to the vicinity of 10-15% appears to be due primarily, if not solely, to this now ubiquitous administration of topical steroids in TH. In addition, in retrospect, there are also a remarkable number (at least 5) of major statistical errors in this literature and another 6 studies of outpatients in which compliance with therapy as outpatients is not even considered. Therefore at least 16 (57%) of the 28 papers reviewed have serious flaws and doubtful or uncertain results or conclusions. Of the 9 papers which lead one to wrongful conclusions, 5 are prejudicial against systemic steroid treatment (and 2 against systemic ACA treatment, and 2 against systemic TXA treatment). All but one of the nine are, as a corollary, prejudicial in favor of non medical treatment of TH. In our 24 cases studied, none suffered a rebleeding episode.


CONCLUSIONS
The "continuing controversy" about medical treatment of TH is the direct result of poor science and poor scientific methods in clinical trials. Because no method has yet been devised to determine which traumatic hyphemas will rebleed, but preventing rebleeding is about all that we can do maximize the outcome, we recommend that all patients with TH receive the Yasuna systemic steroids no touch and/or PLUS protocol in addition to current conventional treatment (bed rest, hospitalization for all patients under 18 years of age)
Romano
P E
PE
Department of Ophthalmology, University of Florida, Gainesville, USA.
Phillips
P J
PJ
D000933:Antifibrinolytic Agents / Q000266:history / Q000627:therapeutic use; D002985:Clinical Protocols; D005131:Eye Injuries / Q000188:drug therapy / Q000209:etiology / Q000266:history*; D005938:Glucocorticoids / Q000266:history* / Q000627:therapeutic use; D049673:History, 20th Century; D006801:Humans; D006988:Hyphema / Q000188:drug therapy / Q000209:etiology / Q000266:history*; D010349:Patient Compliance; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000188:drug therapy / Q000209:etiology / Q000266:history*
D000933:Antifibrinolytic Agents; D005938:Glucocorticoids