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Intraoperative Visualization of Subretinal Injection and Retinal Detachment in Rats

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Retrobulbar Hematoma: Presentation, Management, and Visual Outcomes.

Magdi Elghannam¹, Bashar A Hassan^2,3, Nawal Shams¹

¹University of Maryland School of Medicine.

The Journal of Craniofacial Surgery

|December 20, 2024

Summary

This summary is machine-generated.

Retrobulbar hematoma (RH) is an eye emergency. Lateral canthotomy and cantholysis (LCC) effectively reduces high intraocular pressure (IOP) but does not significantly improve vision outcomes. Presenting visual acuity is the best predictor of recovery.

Keywords:

Orbital fractures orbital trauma retrobulbar hematoma

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Area of Science:

Ophthalmology
Trauma Surgery
Emergency Medicine

Background:

Retrobulbar hematoma (RH) is a critical condition that can lead to irreversible vision loss.
Lateral canthotomy and cantholysis (LCC) is a surgical intervention often employed for RH when intraocular pressure (IOP) is elevated or vision is impaired.

Purpose of the Study:

To analyze the largest cohort of patients with RH to date.
To describe the presentation, management strategies, and visual outcomes for patients with RH.
To evaluate the efficacy of LCC in managing RH and its impact on visual prognosis.

Main Methods:

Retrospective analysis of patients with acute facial trauma and RH at a major shock trauma center (2014-2022).
Data collected included presenting ocular symptoms, signs, IOP, management (LCC vs. observation), and visual acuity (VA).
Statistical analysis was performed to compare outcomes between LCC and observation groups and identify predictors of visual recovery.

Main Results:

Orbital pain and subconjunctival hemorrhage were the most common presenting symptoms/signs in 41 eyes (39 patients).
LCC was performed in 20 cases, with significantly higher presenting IOP compared to the observation group (33 vs. 18 mm Hg).
Patients treated with LCC had a higher incidence of no light perception (NLP) vision at presentation (50% vs. 0%), and presenting VA was the sole significant predictor of follow-up VA.

Conclusions:

LCC is effective in reducing elevated IOP in retrobulbar hematoma, thereby improving intraocular perfusion.
While LCC addresses elevated IOP, it was not associated with significantly improved odds of restoring normal vision.
Presenting visual acuity remains the most reliable prognostic indicator for visual outcomes in patients with retrobulbar hematoma.