Mathew Philip, Adenwalla Hirji Sorab, Narayanan Puthucode V, Nyamu Emily
Department of Plastic Surgery and Burns, The Charles Pinto Centre for Cleft Lip, Palate and Craniofacial Anomalies, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India.
Indian J Plast Surg. 2015 Sep-Dec;48(3):297-300. doi: 10.4103/0970-0358.173129.
Blindness following a LeFort I osteotomy is a rare but extremely serious complication. Ten cases have been reported to date. None of these patients recovered vision. Optic neuropathy is believed to be the cause but the exact mechanism has not been settled. We report the first, and the only two, documented cases of complete loss of vision that recovered subsequently. The first patient was a 19-year-old male with repaired bilateral cleft lip and palate. He developed loss of vision in the right eye on the second postoperative day. The second patient was a 22-year-old male with repaired unilateral cleft lip and palate. He developed complete loss of vision in the left eye on the day of surgery. Both these patients underwent ongoing studies, which did not show any abnormalities. Both were treated with methylprednisolone. Both the patients gradually showed improvement in their vision. The first patient recovered normal vision several months postoperatively. The second patient's vision improved to 4/60 by 4 months postoperatively. We discuss the probable mechanisms of optic nerve injury and also the possible reasons why sight was restored in these patients. This is a rare but serious complication following a fairly common procedure. Through this article we wish to create an awareness of this complication and also a possible way of avoiding such a disaster.
勒福Ⅰ型截骨术后失明是一种罕见但极其严重的并发症。迄今为止，已有10例相关报道。这些患者均未恢复视力。视神经病变被认为是病因，但确切机制尚未明确。我们报告首例且仅有的两例视力完全丧失后又恢复的病例。首例患者是一名19岁男性，双侧唇腭裂已修复。术后第二天右眼失明。第二例患者是一名22岁男性，单侧唇腭裂已修复。手术当天左眼完全失明。这两名患者均接受了后续检查，未发现任何异常。两人均接受了甲泼尼龙治疗。两名患者的视力均逐渐改善。首例患者术后数月恢复了正常视力。第二例患者术后4个月视力提高到4/60。我们讨论了视神经损伤的可能机制以及这些患者视力恢复的可能原因。这是一种在相当常见的手术之后出现的罕见但严重的并发症。通过本文，我们希望引起对这种并发症的关注以及避免此类灾难的可能方法。
