Hospital "Dr. Luis Sánchez Bulnes," Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico; Retina Department, Hospital "Dr. Luis Sánchez Bulnes," Asociación Para Evitar la Ceguera en México I.A.P, Mexico City, Mexico.
Hospital "Dr. Luis Sánchez Bulnes," Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico.
Ophthalmol Retina. 2020 Jul;4(7):708-719. doi: 10.1016/j.oret.2020.01.008. Epub 2020 Jan 13.
To describe preoperative, intraoperative, and postoperative characteristics, imaging findings, and clinical evolution of patients who developed orbital emphysema after vitreoretinal surgery.
Retrospective, descriptive, observational case series.
Patients with orbital emphysema after vitreoretinal surgery who were diagnosed and treated between January 2006 and October 2018 at a single ophthalmology referral center.
Medical records and orbital computed tomography images were reviewed and analyzed. A minimum follow-up of 3 months was required.
Final best-corrected visual acuity (BCVA).
This study included 16 patients with a mean age of 47.9 ± 14.7 years, 50% were women, and 25% had a history of previous ocular trauma. A diagnosis of rhegmatogenous retinal detachment was established in 75% of patients. Twenty-five percent of patients underwent pars plana vitrectomy (PPV), 50% underwent encircling scleral buckling plus PPV, 18.8% underwent repeat PPV, and 6.2% underwent scleral buckling plus repeat PPV. Additionally, 62.5% received silicone oil endotamponade. The median time between vitreoretinal surgery and orbital emphysema was 8 days (interquartile range [IQR] 5-15 days). Mean proptosis was 6.7 ± 4.6 mm. Orbital cellulitis was considered as a differential diagnosis in 31.2% of patients, and tomographic evidence of fracture was observed in 25% of patients. Treatment with compressive patching was prescribed for 87.5% of patients, transpalpebral drainage was prescribed for 75% of patients, hyperbaric oxygen therapy was prescribed for 43.8% of patients, and surgical management was prescribed for 31.2% of patients. The comparison between BCVA before vitreoretinal surgery (median, 1.8 logarithm of the minimum angle of resolution [logMAR]; IQR, 1.33-2.3 logMAR) and at the last follow-up (median, 2.3 logMAR; IQR, 1.42-2.8 logMAR) was not statistically significant (P = 0.125, Wilcoxon matched-pairs signed-rank test). No association was found between surgeon experience and lower final BCVA (P = 0.604, Fisher exact test); however, development of ocular hypertension was associated with worse final BCVA (P = 0.0101; relative risk, 7; 95% confidence interval, 1.01-44.63).
Although orbital emphysema constitutes a very unusual complication of vitreoretinal surgery, it is important to identify this condition promptly and treat patients efficiently to avoid potential vision loss.
描述玻璃体视网膜手术后发生眶气肿的患者的术前、术中及术后特点、影像学表现和临床转归。
回顾性、描述性、观察性病例系列。
2006 年 1 月至 2018 年 10 月期间在一家眼科转诊中心诊断和治疗的玻璃体视网膜手术后发生眶气肿的患者。
回顾性分析患者的病历和眼眶计算机断层扫描图像。需要至少 3 个月的随访。
最终最佳矫正视力（BCVA）。
本研究共纳入 16 例患者，平均年龄为 47.9±14.7 岁，50%为女性，25%有眼部外伤史。75%的患者诊断为孔源性视网膜脱离。25%的患者行玻璃体切除术（PPV），50%的患者行巩膜环扎术+PPV，18.8%的患者行重复 PPV，6.2%的患者行巩膜环扎术+重复 PPV。此外，62.5%的患者接受了硅油眼内填充。玻璃体视网膜手术后至眶气肿发生的中位时间为 8 天（四分位距[IQR]为 5-15 天）。平均眼球突出度为 6.7±4.6mm。31.2%的患者眶蜂窝织炎为鉴别诊断，25%的患者眶 CT 有骨折证据。87.5%的患者接受了压迫性贴敷治疗，75%的患者接受了经皮眶引流，43.8%的患者接受了高压氧治疗，31.2%的患者接受了手术治疗。玻璃体视网膜手术前（中位数，1.8 对数最小角分辨率[logMAR]；IQR，1.33-2.3 logMAR）和末次随访时（中位数，2.3 logMAR；IQR，1.42-2.8 logMAR）BCVA 的比较差异无统计学意义（P=0.125，Wilcoxon 配对符号秩检验）。手术医生经验与最终 BCVA 无相关性（P=0.604，Fisher 确切概率法）；然而，眼压升高与最终 BCVA 较差相关（P=0.0101；相对风险，7；95%置信区间，1.01-44.63）。
尽管眶气肿是玻璃体视网膜手术后非常罕见的并发症，但及时识别这种情况并有效治疗患者以避免潜在的视力丧失非常重要。
