Purpose

Severe vision loss is a risk of orbital surgery which physicians should counsel patients about, but the overall risk rate is unknown. This research was conducted to determine the risk of severe vision loss related to orbital surgery.

Design

Retrospective review.

Participants

Patients who underwent orbital surgery at either of 2 academic medical centers between January 1994 and December 2014.

Methods

A billing database search was conducted to identify all patients who had orbital surgery during the study period, cross-checked against diagnostic codes related to vision loss. Charts were screened to determine baseline demographic and medical history, surgical procedure, intraoperative and perioperative management, and visual acuity. Patients with preoperative visual acuity ≥20/200 that worsened ≤20/400 after orbital surgery were included for detailed review. Statistical analysis was conducted to identify factors posing particular risk or benefit to visual outcome in these patients.

Main Outcome Measures

Visual acuity after orbital surgery.

Results

A total of 1665 patients underwent orbital surgery during the inclusion period, with 14 patients sustaining severe vision loss ranging from counting fingers at 1 foot to no light perception (overall risk, 0.84%). The causes of vision loss included retrobulbar hemorrhage, malpositioned implant, optic nerve ischemia, or direct optic nerve insult. When stratified by surgical approach, the risk of a blinding surgical complication was significantly higher for patients undergoing orbital floor repair in the setting of multiple facial fractures (subgroup risk, 6.45%), bony decompression of the optic canal (subgroup risk, 15.6%), or intracranial approach to the orbital roof (subgroup risk, 18.2%). Seven of 8 patients with a potentially reversible cause of postoperative vision loss underwent urgent repeat surgery, and 2 regained substantial vision (20/20 and 20/25). Administration of intravenous corticosteroids had no significant effect on visual acuity outcome.

Conclusions

The overall risk of severe vision loss after orbital surgery is 0.84%. The subgroup risk is higher in patients undergoing facial polytrauma repair, optic canal decompression, or orbital apex surgery from an intracranial approach. Close postoperative monitoring and urgent assessment and management of acute vision loss may improve visual outcome in some patients.

中文翻译：

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眼眶手术后的发病率，危险因素和失明的管理

目的

严重的视力丧失是眼眶手术的风险，医生应向患者咨询，但总体风险发生率尚不清楚。进行这项研究是为了确定与眼眶手术有关的严重视力丧失的风险。

设计

回顾性审查。

参加者

在1994年1月至2014年12月期间，在两个学术医疗中心中的任何一个进行了眼眶手术的患者。

方法

进行了计费数据库搜索，以识别研究期间所有接受过眼眶手术的患者，并与与视力丧失相关的诊断代码进行了交叉核对。筛选图表以确定基线人口统计学和病史，手术程序，术中和围手术期管理以及视力。术前视力≥20/ 200且眼眶手术后恶化≤20/ 400的患者被纳入详细检查。进行了统计分析，以识别对这些患者构成特殊风险或对视觉结果有益的因素。

主要观察指标

眼眶手术后的视力。

结果

在入选期间，共有1665名患者接受了眼眶手术，其中14名患者的严重视力丧失从手指在1脚数到无光感（总体风险为0.84％）不等。视力丧失的原因包括眼球后出血，植入物放置不当，视神经缺血或直接视神经损伤。当通过手术方法进行分层时，在多发面部骨折的情况下进行眶底修复的患者发生盲手术并发症的风险显着更高（亚组风险为6.45％），视神经管骨性减压（亚组风险为15.6％） ，或颅内入路到眶顶（亚组风险为18.2％）。术后视力丧失可能具有可逆性的8位患者中有7位接受了紧急重复手术，和2个恢复了实质视力（20/20和20/25）。静脉注射皮质类固醇激素对视力预后无明显影响。

结论

眼眶手术后严重视力丧失的总风险为0.84％。在接受面部多创伤修复，视神经管减压或通过颅内入路进行眶尖手术的患者中，该亚组的风险较高。密切的术后监测以及对急性视力丧失的紧急评估和处理可能会改善某些患者的视力。