Maurer P, Conrad-Hengerer I, Hollstein S, Mizziani T, Hoffmann E, Hengerer F
Department of Oral and Plastic Maxillofacial Surgery, Ruhr-University Bochum, Bochum, Germany.
Int J Oral Maxillofac Surg. 2013 Dec;42(12):1510-4. doi: 10.1016/j.ijom.2012.09.024. Epub 2013 Jun 14.
Retrobulbar haemorrhage is a sight-threatening condition that can occur after orbital trauma. The aim of this study was to evaluate the frequency and outcome of orbital haemorrhages following orbital fractures in geriatric patients receiving anticoagulants. All patients aged 65 years or more suffering from orbital fractures between 2008 and 2009 were included in this study. The mechanism of trauma, underlying diseases, and medication were recorded. In case of a retrobulbar haemorrhage, surgical exploration, the elapsed time between the onset of haemorrhage symptoms and surgical treatment, and the outcome regarding visual acuity were documented. Sixty-eight orbital fractures occurred (31 males, 37 females, age 65-95 years) resulting in six (3%) orbital haemorrhages. Four cases were associated with initial orbital bleeding, two other patients developed orbital haemorrhage as a complication after surgical reconstruction. Anticoagulant therapy, but not aspirin, was associated with a significantly increased risk of retrobulbar haematoma (p=0.02). Two patients permanently lost vision, two partial recoveries and two total recoveries were observed. Patients receiving anticoagulants have a higher risk of orbital haemorrhage after orbital fracture and should be monitored closely. Any evidence of visual impairment should lead to further investigation and prompt treatment.
球后出血是一种可发生于眼眶外伤后的视力威胁性疾病。本研究的目的是评估老年抗凝患者眼眶骨折后眼眶出血的发生率及预后。本研究纳入了2008年至2009年间所有年龄在65岁及以上的眼眶骨折患者。记录外伤机制、基础疾病及用药情况。发生球后出血时，记录手术探查情况、出血症状出现至手术治疗的时间间隔以及视力预后情况。共发生68例眼眶骨折（男性31例，女性37例，年龄65 - 95岁），其中6例（3%）发生眼眶出血。4例与初始眼眶出血有关，另外2例患者在手术重建后发生眼眶出血作为并发症。抗凝治疗（而非阿司匹林）与球后血肿风险显著增加相关（p = 0.02）。观察到2例患者永久性失明，2例部分恢复，2例完全恢复。接受抗凝治疗的患者眼眶骨折后发生眼眶出血的风险较高，应密切监测。任何视力损害的迹象都应导致进一步检查和及时治疗。
