Successful Management of a Spontaneous Retrobulbar Hematoma After Heart Transplantation. A Case Report

Cruz, Gustavo; Gómez, Santiago Pedroza; Arango, Akemi; Galvis, Andrea; Lemos, Joaquin  O.

doi:10.1016/j.transproceed.2023.02.035

Transplantation Proceedings

2023

DOI: 10.1016/j.transproceed.2023.02.035

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Successful Management of a Spontaneous Retrobulbar Hematoma After Heart Transplantation. A Case Report

Gustavo Cruz

Santiago Pedroza Gómez

Akemi Arango

et al.

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2024

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Cited by 2 publications

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Asymmetric, Bilateral Nontraumatic Subperiosteal Orbital Hematomas in an Anticoagulated Patient Following Anesthesia in Prone Positioning

Kao,

Meer,

Ahmad

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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The authors report a case of nontraumatic orbital subperiosteal hematoma after general anesthesia with patient in the prone position. The patient, who was on aspirin, clopidogrel, and subcutaneous heparin, presented immediately after sacral ulcer debridement with acute bilateral vision loss and periorbital edema. While the OD improved with conservative management, the OS continued to have 20/200 vision, decreased color vision, afferent pupillary defect, and extraocular movement limitation after lateral canthotomy and cantholysis. Imaging revealed bilateral subperiosteal hematomas in the superior orbital roof stretching the posterior optic nerve. Left orbitotomy with drainage of hematoma under anesthesia was then performed, with full resolution of symptoms and recovery of vision to 20/20 by postoperative week 2. While a few cases of orbital subperiosteal hematoma after nonophthalmic surgeries have been previously reported, the majority were in the supine position, unilateral, and resolved without surgical decompression. This case suggests that the increase in venous pressure from prone positioning, especially in patients on anticoagulation or antiplatelet therapy, could contribute to bleeding into the subperiosteal space. Furthermore, although the orbital compartment syndrome and elevated intraocular pressure resolved with canthotomy/cantholysis, there was persistent compressive optic neuropathy that required surgical intervention.

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Asymmetric, Bilateral Nontraumatic Subperiosteal Orbital Hematomas in an Anticoagulated Patient Following Anesthesia in Prone Positioning

Kao,

Meer,

Ahmad

et al. 2024

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Retrobulbar Hematoma: Presentation, Management, and Visual Outcomes

Elghannam,

Hassan,

Shams

et al. 2024

Journal of Craniofacial Surgery

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Retrobulbar hematoma (RH) is a diagnostic and therapeutic emergency that may cause permanent vision loss. Lateral canthotomy and cantholysis (LCC) is typically performed when IOP is elevated or vision is compromised. The authors describe the outcomes of the largest cohort of patients with RH to date. Patients who presented with acute facial trauma and RH to the R. Adams Cowley Shock Trauma Center (2014–2022) were analyzed to describe their presentation, management, and visual outcomes. In 41 eyes (39 patients) with RH, the most common presenting ocular symptoms and signs were orbital pain [19 (46%)] and subconjunctival hemorrhage [33 (81%)], respectively. LCC was performed in half the cases (n=20). The median (IQR) intraocular pressure (IOP) was significantly higher in the LCC group versus observation: 33 mm Hg (26–44) versus 18 mm Hg (15–21) (P=0.001). Compared with the observation group, patients treated by LCC were significantly more likely to have no light perception (NLP) vision [0 (0%) versus 6 (50%), P=0.004] and higher IOP [median [IQR] 16 mm Hg (15–21) versus 33 mm Hg (23–44), P=0.001] at presentation. Although 1 of the 6 NLP patients managed by LCC regained some vision, LCC was not associated with significantly different odds of restoration of normal vision [aOR (95% CI) 0.32 (0.04–2.98)]. Visual acuity (VA) at presentation was the only significant predictor of visual acuity after follow-up (B=0.64, P=0.016). LCC is indicated for elevated IOP, as it effectively reduces IOP and improves intraocular perfusion. VA at presentation is the most reliable predictor of VA on follow-up.

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Successful Management of a Spontaneous Retrobulbar Hematoma After Heart Transplantation. A Case Report

Cited by 2 publications

References 7 publications

Asymmetric, Bilateral Nontraumatic Subperiosteal Orbital Hematomas in an Anticoagulated Patient Following Anesthesia in Prone Positioning

Asymmetric, Bilateral Nontraumatic Subperiosteal Orbital Hematomas in an Anticoagulated Patient Following Anesthesia in Prone Positioning

Retrobulbar Hematoma: Presentation, Management, and Visual Outcomes

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