Jaru-Ampornpan Pimkwan, Joseph Shannon S, Grisolia Ana B Diniz, Briceno Cesar A
Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan , Ann Arbor , Michigan , USA.
Department of Ophthalmology, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand.
Orbit. 2019 Dec;38(6):519-523. doi: 10.1080/01676830.2019.1639771. Epub 2019 Jul 16.
The authors describe the first report in the literature of delayed orbital hemorrhage that may be partly caused by supratherapeutic anticoagulation. A 52-year-old man with supratherapeutic international normalized ratio (INR) presented with acute proptosis, orbital pain and diplopia 9 months after the floor and medial orbital wall fracture repair using nylon foil implant. He was found to have hemorrhaged into the capsule surrounding the orbital implant. Three weeks later, the patient underwent implant removal after warfarin was discontinued for 5 days and INR was normalized. His symptoms resolved postoperatively. This case describes a unique risk factor of delayed orbital hemorrhage in patients with previous orbital fracture repair, and highlights that coagulopathy should be investigated in patients presenting with acute proptosis with a history of orbital fracture repair. The authors also provide a comprehensive and up-to-date literature review on previously reported cases with delayed hemorrhagic complications from alloplastic orbital implants.
作者描述了文献中首例可能部分由超治疗剂量抗凝引起的迟发性眼眶出血报告。一名国际标准化比值（INR）超治疗剂量的52岁男性，在使用尼龙箔植入物修复眶底和眶内侧壁骨折9个月后，出现急性眼球突出、眼眶疼痛和复视。发现他眼眶植入物周围的包膜内出血。三周后，在停用华法林5天且INR恢复正常后，患者接受了植入物取出术。术后他的症状得到缓解。该病例描述了既往眼眶骨折修复患者迟发性眼眶出血的一个独特危险因素，并强调对于有眼眶骨折修复病史且出现急性眼球突出的患者，应调查其凝血功能障碍情况。作者还对先前报道的异体眼眶植入物迟发性出血并发症病例进行了全面且最新的文献综述。
