Park Jae Hwi, Kim Inhye, Son Jun Hyuk
Department of Oculoplasty, Nune Eye Hospital, Daegu, South Korea.
Department of Ophthalmology, Yeungnam University Medical Center, 317-1, Daemyung dong, Nam-Gu, Daegu, 705-035, South Korea.
BMC Ophthalmol. 2021 Apr 22;21(1):186. doi: 10.1186/s12886-021-01943-1.
Retrobulbar hemorrhage (RBH) is a rare complication after orbital surgery but associated with ocular complications including blindness. The aim of this study was to identify clinical characteristics of patients with RBH requiring emergent orbital decompression after blowout fracture repair.
A retrospective review of 426 blowout fracture patients at a tertiary oculoplastic clinic provided data regarding demographics, physical examination findings, and computed tomography (CT) images. Extraocular motility had been recorded in patient charts on a scale from 0 to - 4. Patients requiring emergent orbital decompression due to RBH after surgery (RBH group) were compared with those who did not (Control group), using the Mann-Whitney U-test. Incidences of RBH according to primary or secondary surgery were also investigated, using Fisher's exact test.
Five (1.2%) of the 426 patients who underwent blowout fracture repair developed RBH requiring emergent intervention. All RBH patients fully recovered after the decompression procedure or conservative treatment. Number of days to surgery was significantly longer in the RBH group (97.0 ± 80.1) than in the Control group (29.0 ± 253.0) (p = 0.05). Preoperative enophthalmos was also significantly greater in the RBH group (RBH vs. Control group, 3.6 ± 1.7 mm versus 1.2 ± 1.3 mm (p = 0.003)). The incidence of RBH was significantly higher in patients that underwent secondary surgery (odds ratio = 92.9 [95% confidence interval, 11.16-773.23], p = 0.001).
Surgeons should pay more attention to hemostasis and postoperative care in patients with a large preoperative enophthalmic eye, when time from injury to surgery is long and in revision cases. When RBH occurs, time to intervention and surgical decompression is critical for visual recovery and preventing blindness.
The institutional review board of the Yeungnam University Medical Center approved this study ( YUMC 2018-11-010 ), which was conducted in accord with the Declaration of Helsinki.
球后出血（RBH）是眼眶手术后一种罕见的并发症，但与包括失明在内的眼部并发症相关。本研究的目的是确定在爆裂性骨折修复后需要紧急眼眶减压的RBH患者的临床特征。
对一家三级眼整形诊所的426例爆裂性骨折患者进行回顾性研究，提供了有关人口统计学、体格检查结果和计算机断层扫描（CT）图像的数据。眼外肌运动在患者病历中按0至-4级记录。使用Mann-Whitney U检验，将术后因RBH需要紧急眼眶减压的患者（RBH组）与未需要紧急眼眶减压的患者（对照组）进行比较。还使用Fisher精确检验调查了初次手术或二次手术患者的RBH发生率。
426例接受爆裂性骨折修复的患者中有5例（1.2%）发生了需要紧急干预的RBH。所有RBH患者在减压手术或保守治疗后均完全康复。RBH组的手术天数（97.0±80.1）明显长于对照组（29.0±253.0）（p=0.05）。RBH组术前眼球内陷也明显更严重（RBH组与对照组，3.6±1.
