Hass Andrea N, Penne Robert B, Stefanyszyn Mary A, Flanagan Joseph C
Wills Eye Hospital, Department of Oculoplastics, Philadelphia, Pennsylvania, USA.
Ophthalmic Plast Reconstr Surg. 2004 Nov;20(6):426-32. doi: 10.1097/01.iop.0000143711.48389.c5.
Orbital hemorrhage, especially when associated with visual loss, is a significant complication of cosmetic eyelid surgery. We investigated the incidence of this complication among cases handled by members of the American Society of Ophthalmic Plastic and Reconstructive Surgery. We also reviewed the length of time between surgery and the onset of bleeding and sought any factors that may contribute to these cases.
A 2-page questionnaire was sent to all American Society of Ophthalmic Plastic and Reconstructive Surgery members. Responses were tabulated as to total numbers of cases performed, the incidence of postoperative orbital hemorrhage, treatments, and incidence of permanent visual loss. Comorbidities were also reviewed.
Two hundred thirty-seven responses were received from American Society of Ophthalmic Plastic and Reconstructive Surgery members, collectively representing 269,433 cases. Among these cases, there were 149 orbital hemorrhages, 48 cases associated with temporary visual loss, and 12 cases associated with permanent visual loss. The majority of these cases occurred within the first 3 hours of surgery, and the risk decreased significantly after 24 hours after surgery. Common comorbidities were hypertension, perioperative aspirin use, postoperative vomiting, and increased physical activity. Treatment commonly consisted of wound drainage with cauterization of active bleeders, lateral canthotomy, intravenous steroids, and intraocular pressure-lowering drugs. Orbital decompression was infrequently used; anterior chamber paracentesis was not used. This study is limited by recall biases regarding the number of cases performed by each responding surgeon and the number of relevant cases of orbital hemorrhage.
The incidence of orbital hemorrhage associated with cosmetic eyelid surgery is 0.055% (1:2,000), and orbital hemorrhage with permanent visual loss is 0.0045% (1:22,000) [corrected] Development of orbital hemorrhage is most common within the first 24 hours after surgery, especially within the first 0 to 3 hours, but can occur as late as several days after surgery.
眼眶出血，尤其是伴有视力丧失时，是眼部整形手术的一种严重并发症。我们调查了美国眼科整形与重建外科学会成员所处理病例中该并发症的发生率。我们还回顾了手术与出血发生之间的时间间隔，并寻找可能导致这些病例的任何因素。
向所有美国眼科整形与重建外科学会成员发送了一份两页的问卷。对回复进行了汇总，包括手术总例数、术后眼眶出血的发生率、治疗方法以及永久性视力丧失的发生率。还对合并症进行了回顾。
收到了美国眼科整形与重建外科学会成员的237份回复，总共代表269,433例病例。在这些病例中，有149例眼眶出血，48例伴有暂时性视力丧失，12例伴有永久性视力丧失。这些病例大多数发生在手术的前3小时内，术后24小时后风险显著降低。常见的合并症有高血压、围手术期使用阿司匹林、术后呕吐以及身体活动增加。治疗通常包括伤口引流并烧灼活跃出血点、外眦切开术、静脉注射类固醇以及降低眼压的药物。很少使用眼眶减压术；未使用前房穿刺术。本研究受到每个回复外科医生所做病例数以及眼眶出血相关病例数的回忆偏倚的限制。
眼部整形手术相关眼眶出血的发生率为0.055%（1:2,000），伴有永久性视力丧失的眼眶出血发生率为0.0045%（1:22,000）[已校正]。眼眶出血最常发生在术后24小时内，尤其是最初的0至3小时内，但也可能在术后数天出现。
