Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Prendes, M. A. González; Gudgel, Brett; Kassa, Enoch; Todd, Amelia M.; Fu, Roxana; Abou-Jaoude, Michelle; Timoney, Peter J.; Shipchandler, Taha Z.; Nunery, William R.; Lee, H.B. Harold

doi:10.1016/j.amjoto.2019.04.008

Cited by 9 publications

(5 citation statements)

References 10 publications

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“…Orbital implants generally do not require fixation as the orbital soft tissues gently tamponade the implant in place and prevent significant movement. 6–8 Review of the literature does not find a significant difference in retrobulbar hemorrhage incidence between fixated and nonfixated orbital implants. 7–10 In our patient, fixating the implant to the orbit with a screw may have prevented or decreased superior displacement from the CPAP.…”

Section: Discussionmentioning

confidence: 95%

“…6–8 Review of the literature does not find a significant difference in retrobulbar hemorrhage incidence between fixated and nonfixated orbital implants. 7–10 In our patient, fixating the implant to the orbit with a screw may have prevented or decreased superior displacement from the CPAP. Still, implant fixation would not have guaranteed against bleeding, and there are reports of postoperative retrobulbar hemorrhages despite fixation with either titanium screws or stainless-steel wires.…”

Section: Discussionmentioning

confidence: 95%

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Recurrent Retrobulbar Hemorrhage Associated With CPAP Use After Orbital Fracture Repair

Ryu

Geelan-Hansen

Chundury

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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We present a patient who underwent orbital fracture repair complicated by retrobulbar hemorrhages twice within the first postoperative week. The suspected cause is continuous positive airway pressure (CPAP) use with inappropriate patient-modified settings. The most likely mechanism of action was venous congestion from the extrinsic positive pressure, similar to Valsalva maneuvers increasing orbital vasculature pressure. In our patient, because his orbital blood vessels had recently been cauterized, they were too fragile to handle the engorgement and bled, leading to a retrobulbar hemorrhage. It is possible that at a lower CPAP setting, the vascular congestion would not have been as severe and caused bleeding. We recommend routinely asking patients about CPAP use before orbital surgeries and instructing patients to stop CPAP usage for 1 week after any orbital surgeries if medically cleared.O bstructive sleep apnea is a common condition, affecting about 15% of males and 5% of females in the United States. 1 The first-line treatment is nightly use of continuous positive airway pressure (CPAP). Complications of CPAP use are

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 95%

Recurrent Retrobulbar Hemorrhage Associated With CPAP Use After Orbital Fracture Repair

Ryu

Geelan-Hansen

Chundury

2022

Ophthalmic Plastic &Amp; Reconstructive Surgery

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“…Prendes et al specifically studied the rate of intracapsular hemorrhage in a retrospective study of 227 patients at a single institution. 9 During four years of follow up, no patients were found to have intracapsular hemorrhage. The authors suggested that implants with increased rigidity and thickness may have a higher risk of forming fragile bridging vessels, which may lead to intracapsular hemorrhage.…”

Section: Discussionmentioning

confidence: 96%

Delayed orbital floor implant complications: Case report and review of the literature

Soetikno,

Losorelli,

Charoenkijkajorn

et al. 2024

American Journal of Ophthalmology Case Reports

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“…Nylon foil has been associated with delayed intracapsular hemorrhage. 19 Porous polyethylene has been associated with late-onset infections, occurring from 10 months to 8 years after surgery. 20 Bare titanium implants have been associated with orbital adherence syndrome, and a patient who received a silicone orbital implant had a spontaneous extrusion of the implant 30 years after it was placed.…”

Section: Discussionmentioning

confidence: 99%

Do Orbital Implants Differ in Complication Rates: A Retrospective Study of 88 Patients, and an Argument for Cost-Effective Practices in the Face of Rising Health Care Costs

et al. 2021

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Operative repair of orbital fractures utilizes implants constructed of a plethora of materials that vary in cost. Surgeon preference as well as fracture complexity may dictate the implant chosen. In this study, we retrospectively compared the complication rates of the four most common types of implants utilized at our institution. We found no significant difference in complication rates in our sample of 88 patients. Additionally, the least expensive implant was as effective as the most expensive implant in addressing isolated orbital blowout fractures. This situation is not unique to the field of oculoplastics. As evidenced from published literature in other areas of surgery, from orthopaedics to orthodontics, cheaper alternatives often afford similar outcomes as more expensive options. We herein argue that a cost-effective approach should be considered while still allowing for high quality of care, in the face of rising health care costs and health disparities in America.

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Intracapsular hemorrhage rates in non-fixated nylon sheet orbital implants for orbital fracture management

Cited by 9 publications

References 10 publications

Recurrent Retrobulbar Hemorrhage Associated With CPAP Use After Orbital Fracture Repair

Recurrent Retrobulbar Hemorrhage Associated With CPAP Use After Orbital Fracture Repair

Delayed orbital floor implant complications: Case report and review of the literature

Do Orbital Implants Differ in Complication Rates: A Retrospective Study of 88 Patients, and an Argument for Cost-Effective Practices in the Face of Rising Health Care Costs

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