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Blindness risk after surgery high in patients undergoing orbital floor repair, bony decompression

27 Jul 2018

A recent study has shown a 0.84-percent overall risk of severe vision loss following orbital surgery, and 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,” the investigators said.

Orbital surgery was performed in 1,665 patients during the study period. Of these, 14 sustained severe vision loss ranging from counting fingers at 1 foot to no light perception (overall risk, 0.84 percent). The causes of vision loss were as follows: retrobulbar haemorrhage, malpositioned implant, optic nerve ischaemia or direct optic nerve insult.

Stratification by surgical approach showed a significantly greater risk of a blinding surgical complication for patients undergoing orbital floor repair in the setting of multiple facial fractures (subgroup risk, 6.45 percent), bony decompression of the optic canal (subgroup risk, 15.6 percent) or intracranial approach to the orbital roof (subgroup risk, 18.2 percent).

Eight patients had a potentially reversible cause of postoperative vision loss, of which seven underwent urgent repeat surgery and two regained substantial vision (20/20 and 20/25). Furthermore, there was no significant effect on visual acuity outcome with administration of intravenous corticosteroids.

The investigators searched a billing database, cross-checked against diagnostic codes related to vision loss, to identify all patients who had orbital surgery during the study period. They also screened charts to determine baseline demographic and medical history, surgical procedure, intraoperative and perioperative management, and visual acuity.

A detailed review was performed among patients with preoperative visual acuity ≥20/200 that worsened ≤20/400 after orbital surgery. Factors posing a particular risk or benefit to visual outcome in these patients were identified using statistical analysis.

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