title: Efficacy of transcutaneous transseptal orbital decompression in treating acute retrobulbar hemorrhage and a literature review.
abstract: Decreasing visual acuity secondary to orbital trauma may be caused by sudden space-occupying or expanding intraorbital lesions, including retrobulbar hemorrhage (RBH), herniation, or swelling. RBH must be diagnosed and treated immediately. This article addresses the efficacy of transcutaneous transseptal orbital decompression in a combination with a systematic review of the literature for a comparison of this method with existing treatment options. For this study the department's database was retrospectively screened for patients with acute RBH who were treated between 2009 and 2011 using the authors' approach. Patients presenting with RBH were classified into RBH classes I to III according to three different clinical and radiological manifestations of acute RBH. The efficacy of transcutaneous transseptal orbital decompression was assessed by postoperative visual acuities. The literature review was performed by using the MEDLINE database. The time period for the study was between 2009 and 2011 during which 10 patients were diagnosed with suspected RBH and 9 were treated with the authors' technique. Visual acuities were reconstituted or maintained in almost 86% of patients who were diagnosed and treated according to the authors approach and who survived initial trauma. It was concluded that transcutaneous transseptal orbital decompression provides an efficient and rapid approach for treating patients with acute RBH. By distinguishing three different manifestations of acute RBH, the authors present a diagnostic tool that may facilitate classification of RBH and determination of treatment options.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Zimmerer
authors.affiliation: Department of Ophthalmology, Hannover Medical School, Hannover, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Schattmann
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School.
authors.forename: Harald
authors.initials: H
authors.lastname: Essig
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School.
authors.forename: Philipp
authors.initials: P
authors.lastname: Jehn
authors.affiliation: Department of Oral and Maxillofacial Surgery, University of Freiburg Medical School, Freiburg, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Metzger
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School.
authors.forename: Horst
authors.initials: H
authors.lastname: Kokemüller
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School.
authors.forename: Nils-Claudius
authors.initials: NC
authors.lastname: Gellrich
authors.affiliation: Department of Oral and Maxillofacial Surgery, Hannover Medical School.
authors.forename: Frank
authors.initials: F
authors.lastname: Tavassol
keywords: VEP; amaurosis; optic nerve trauma; orbital trauma; retrobulbar hematoma; retrobulbar hemorrhage