Assessing risk for postoperative severe vision impairment following orbitotomy

A retrospective analysis was conducted in patients who underwent orbitotomy for primary intraconal tumors to determine the rate of postoperative severe vision impairment (PSVI) and the most common risk factors for PSVI.

Study design

This study included 165 cases of primary intraconal tumors in patients who underwent orbitotomy between 2010 and 2015 in a single eye hospital in China. Patients who had PSVI, defined as visual acuity ≤20/400 or ≥4 rows of visual decline, were identified.

Outcomes

Of the 165 total cases, 12 cases of PSVI were identified; 3 of the 165 cases had no light perception vision. The authors found that independent risk factors for PSVI included intraoperative tight adhesion (odds ratio [OR] 12.03; 95% confidence interval [CI]: 2.28, 63.44), severe optic nerve displacement (OR 6.01; 95% CI: 1.18, 30.47), and tumors in the orbital apex (defined as reaching the supraorbital fissure or optic nerve canal) (OR 4.91; 95% CI: 1.01, 23.87).

Limitations

Compared with previous studies of visual loss after orbitotomy, this is a relatively small study. A larger number of patients may allow other risk factors to be identified. 

Clinical significance

Although PSVI is a known risk of orbital surgery, this study helps the surgeon preoperatively counsel the patient and prepare for surgeries with a particularly higher risk of PSVI. Preoperative identification of an intraconal tumor in the orbital apex and severe optic nerve displacement should be red flags for the physician. In addition, intraoperative tight adhesion of the tumor should also warn the surgeon to proceed with caution.