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Jaehwi Park, Hyun-ju Oh, Eunyoung Cho, Wonyung Son, Sooncheol Cha, JunHyuk Son; Clinical characteristics of retrobulbar hemorrhage following blow out fracture repair. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5626.
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Retrobulbar hemorrhage (RH) is rarely seen, yet can be devastating if not treated properly. We performed a retrospective, observational clinical study to identify clinical characteristics of RH patients requiring emergent orbital decompression after blow out fracture repair.
A retrospective review of 426 blow out fracture patients at a tertiary oculoplastic clinic provided data regarding demographics, physical examination findings, and computed tomography (CT) images. Extraocular motility had been recorded in the chart on a scale from 0 to -4. Patients requiring emergent orbital decompression due to RH after the surgery (RH group) were compared with those who did not (Control group), using Mann-Whitney U-test. The incidence of RH according to primary or secondary surgery was also investigated, using fisher’s exact test. The clinical risk factors for RH after surgery were identified based on univariate and multivariate analyses.
Six (1.4%) developed RH requiring emergent decompression among 426 patients who underwent blow out fracture repair. All RH patients were fully recovered after the decompression procedure. Days to surgery was significantly longer in the patients with the RH (85.83 ± 76.73) compared with Control group (47.67 ± 314.09) (p = 0.03). Preoperative extraocular motility limitation was significantly more severe in RH group (-4.25 ± 5.38) compared with Control group (-0.75 ± 1.68) (p = 0.027). Preoperative enophthalmos was also statistically greater in RH group (3.00 ± 2.10) compared with Control group (0.96 ± 1.53) (p = 0.014). The incidence of RH in secondary surgery group was significantly higher compared with that of primary surgery group (odds ratio = 69.5 [95% confidence interval, 9.017-535.702], p = 0.002). In logistic regression study, the main factor related with RH development was preoperative extraocular motility limitation (hazard ratio =1.364 [95% confidence interval, 1.126-1.653], p = 0.002).
Risk factors for vision-threatening RH include days to surgery, preoperative extraocular motility limitation and enophthalmos, secondary surgery. Thus, orbital surgeon should be more concerned with hemostasis during surgery and postoperative care in case of such patients
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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