ACTA OPHTHALMOLOGICA VOL. 4 0 1962

Prom the E y e Department, .Rigshospitalet, Copenhagen (Head: Professor H . Ehlers, M . D . )

TRAUMATIC HYPHAEMA. 11.

Prognostic Significance of Admission Practice")

BY

Eilif Gregersen

As mentioned in the preceding paper, ,Traumatic Hyphaema. I<< the favour- able prognosis of traumatic hyphaema in the series from the Copenhagen City Hospital must be assumed to be due to the local practice of referral and ad- mission. According to this practice, patients with small hyphaemas are also admitted, even when they do not have notable associated lesions. Thus, the series from the Eye Department of the Copenhagen City Hospital must be considered fairly >>unloaded<<.

The role played by the referral and admission practice is also apparent from the following analysis of the prognosis of traumatic hyphaema from another eye department in Copenhagen, viz. the Eye Department of Rigshospitalet. This series comprises 100 successive patients with traumatic hyphaema admitted during the years 1955-1961 inclusive. Five of these patients developed secon- dary haemorrhage - with increased tension in two of them. Twelve of the 100 patients ended with considerable visual impairment as evident from the following tabulation on the causes of visual impairment (cf. table 1) .

Owing to the admission practice at the Eye Department of Rigshospitalet, Copenhagen, this series of hyphaema is more >>loaded<< with associated lesions than that from the Copenhagen City Hospital, since patients with small hyphaemas and without notable associated lesions are more rarely referred to Rigshospitalet than to the City Hospital. The Eye Department of Rigshospi- talet receives patients from the entire country, whereas the Copenhagen City Hospital serves the city of Copenhagen. This difference in admission practice is reflected in the incidence and nature of associated lesions and in the

Read before the Danish Ophthalmological Society on February 17th, 1962. ") Received January 13rd 1962.

200

Table 1 . Causes of visual impairment.

Retinal detachment (following vitreous haem. and choroid rupture) ...........

Choroid rupture and central lesion .... Cataract (in one of the cases following sec. haem. with sec. glaucoma) ........

Phthisis bulbi (following sec. haem. with sec. glaucoma treated with paracentesis) Optic atrophy (following sec. glaucoma without sec. haem.) . . . . . . . . . . . . . . . . . . . Permanent vitreous opacities (following vitreous haem.) ......................

3 cases (vision between no light perception

3 ,, (vision between 0.5/60 and 6/60) and 6/36)

3 ,, (vision between hand movements and 6/18)

1 ,, (vision light perception)

1 ,, (vision hand movements)

1 ,, (vision 6/36)

ultimate prognosis. I t may be mentioned, for instance, that the incidence of associated contusion lesions, such as iridic dialysis, vitreous haemorrhage, choroid rupture, and retinal haemorrhage was more than twice as high in the series from the Eye Department of Rigshospitalet as in that from the City Hospital.

SUMMARY

This is an account of the prognosis of traumatic hyphaema in 100 successive patients admitted to the Eye Department, Rigshospitalet, Copenhagen. In this series the prognosis was considerably poorer than that in patients admitted to the Eye Department of the Copenhagen City Hospital (cf. the preceding paper .Traumatic Hyphaema. I<<).

The incidence of secondary haemorrhage was the same in both series, vih approx. 5 O/O. The explanation of the difference in prognosis is that owing to admission practice the incidence of serious associated lesions is appreciably higher in the series from Rigshospitalet than in that of the City Hospital.

- For references to the literature, cf. the preceding paper: *Traumatic Hyphaema. I<<.

20 1