Unilateral Orbital Emphysema Secondary to Vitreoretinal Surgery.

Autor:	Enríquez AB; 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. Electronic address: anabetyenriquezg@gmail.com., Wheelock-Gutierrez L; Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico., Golzarri MF; Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico., Planella S; Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico; Oculoplastics Department, Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P, Mexico City, Mexico., Salcedo-Villanueva G; 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., Salcedo-Casillas G; Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico; Oculoplastics Department, Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P, Mexico City, Mexico., Ceriotto A; Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico; Oculoplastics Department, Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P, Mexico City, Mexico., Rubio RI; Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P., Mexico City, Mexico; Oculoplastics Department, Hospital 'Dr. Luis Sánchez Bulnes,' Asociación Para Evitar la Ceguera en México I.A.P, Mexico City, Mexico., Morales-Canton V; 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.
Jazyk:	angličtina
Zdroj:	Ophthalmology. Retina [Ophthalmol Retina] 2020 Jul; Vol. 4 (7), pp. 708-719. Date of Electronic Publication: 2020 Jan 13.
DOI:	10.1016/j.oret.2020.01.008
Abstrakt:	Purpose: To describe preoperative, intraoperative, and postoperative characteristics, imaging findings, and clinical evolution of patients who developed orbital emphysema after vitreoretinal surgery. Design: Retrospective, descriptive, observational case series. Participants: Patients with orbital emphysema after vitreoretinal surgery who were diagnosed and treated between January 2006 and October 2018 at a single ophthalmology referral center. Methods: Medical records and orbital computed tomography images were reviewed and analyzed. A minimum follow-up of 3 months was required. Main Outcome Measures: Final best-corrected visual acuity (BCVA). Results: 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). Conclusions: 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. (Copyright © 2020 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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