Orbital Decompression Research Articles

The Outcome of One-to-Four Muscle Surgery by Intraoperative Relaxed Muscle Positioning with Adjustable Suture Technique in Thyroid Eye Disease.

PurposeTo identify the outcome of one-to-four muscle surgery by intraoperative relaxed muscle positioning with adjustable suture technique for the treatment of thyroid eye disease.MethodsNinety patients diagnosed with thyroid eye disease who underwent intraoperative relaxed muscle positioning with adjustable suture technique at Ramathibodi Hospital from January 1, 2015 through December 31, 2020 were included in this retrospective study. The patient demographic data were evaluated. Pre- and post-operative ocular alignment and diplopia status were measured after a follow-up period of at least 6 months. Successful outcomes were categorized into two parts: motor outcome and sensory outcome. Successful motor outcome was defined as vertical deviation equal to 4 prism diopters or less and horizontal deviation equal to 10 prism diopters or less in primary position. Successful sensory outcome was defined as the absence of diplopia in primary position.ResultsNinety patients were included in this study, and the mean age of strabismic surgery was 56.6 ± 10.1 years old. Thirty-nine patients had a history of orbital decompression surgery. Mean follow-up time was 33.7 ± 11.8 months. The success of motor and sensory outcomes exhibited a decrease from one-to-four muscle surgery. Motor success decreased from one-muscle to four-muscle surgery (84.62%, 81.58%, 75.00%, and 64.29%) and sensory success similarly decreased (84.62%, 84.21%, 75.00%, and 78.57%). However, the comparative outcomes of motor success and sensory success were not statistically different among groups (p = 0.58 and 0.84). Lower lid retractions were found in 12 patients (13.33%).ConclusionIntraoperative relaxed muscle positioning technique might be a successful option for the correction of thyroid eye disease-associated strabismus. This technique may be done with one-to-four muscle surgery, which yields success in both motor and sensory outcomes.

Changes in Eyelid Pressure and Dry Eye Status after Orbital Decompression in Thyroid Eye Disease.

The aim of this prospective observational study was to examine changes in eyelid pressure and dry eye status after orbital decompression in thyroid eye disease (TED). In 16 patients (29 sides), upper eyelid pressure at plateau phase and maximum pressure were measured. TED status was evaluated through the Hertel exophthalmometric value and margin reflex distance (MRD)-1 and 2. Dry eye status was quantified through corneal fluorescein staining, tear break-up time, Schirmer test I results, meibomian gland dysfunction (MGD), tear meniscus height, and superior limbic keratoconjunctivitis (SLK). Patients were classified into two groups: patients with decreased eyelid pressure (Group 1) and those with elevated pressure (Group 2). Consequently, neither the maximum upper eyelid pressure nor pressure at plateau phase significantly changed after surgery (p > 0.050). Some parameters about MGD improved after surgery, but the other parameters on dry eye, MGD, and SLK worsened or did not change. MRD-1 decreased more (p = 0.028), and the ratio of patients in whom SLK improved after surgery was larger in Group 1 (p = 0.030). These results indicate that upper eyelid pressure tends to decrease postoperatively in patients with a high upper eyelid position, resulting in improvement of SLK.

Withdrawal: “Traumatic optic neuropathy: A case report” Dina M. Abdulmannan

A case of visual loss following craniomaxillofacial trauma is reported. The patient had sudden visual loss associated with fracture of the left orbital floor and medial and lateral wall of the left orbit and comminuted fracture of the left optic canal. Access to the orbit was achieved through endonasal endoscope and resecting the bone fragments, which had impinged on the optic nerve. The patient had total return of visual acuity without surgical complication. The role of orbital and optic decompression in the management of patients with traumatic optic neuropathy is discussed. Its indication is controversial and the procedure should be considered only within the context of the specific needs of the individual patient.

Blepharoptosis in thyroid eye disease: etiopathogenesis, clinical features and correlation with thyroid eye disease.

To report the etiopathogenesis and clinical features of blepharoptosis in patients with thyroid eye disease. A 10-year retrospective interventional study. The etiopathogenesis, laterality, clinical features, and management of Blepharoptosis in thyroid eye disease (TED) were assessed. A total of 1000 patients of TED were evaluated in the 10-year period, of which 55 (5.5%) presented with Blepharoptosis. The average age at presentation was 44.8years, and 31 (56.4%) were males. Of the 41 cases where referral diagnosis was available, TED was suspected in only 2 cases. Of the 55, 25 patients were inactive (TED duration ≥ 12months), and 29 were silent presenters (TED duration ≤ 12months, but clinical activity score ≤ 3). Ptosis was the primary presenting symptom in 14 cases. Ptosis was aponeurotic in 38 cases, myasthenic in 13 cases, congenital in 2 cases, and indeterminate in 2 cases. Orbital imaging was available in 26 cases, of which fat disease was noted in 14 cases. Average amount of ptosis was 2.21mm (range 1-6mm). Lower eyelid retraction (average 2.1mm) was noted in 49 patients. Surgical management was performed in 10 patients, of which 4 underwent a unique combined surgery (orbital decompression with levator reattachment/resection). In patients with TED, blepharoptosis constitutes 5.5% at presentation to a tertiary eye care centre. Blepharoptosis masks upper eyelid retraction as a clinical sign of TED. Commonest cause was acquired aponeurotic ptosis. A combined levator surgery is possible with orbital decompression in such cases.

Correction of lower eyelid retraction combined with entropion in thyroid eye disease patients of East Asian ancestry.

This study evaluates causes and treatment of lower eyelid retraction with co-existing entropion in Thyroid Eye Disease (TED) patients of East Asian ancestry. The medical records for 25 eyelids from 15 TED patients with lower eyelid retraction and entropion who had undergone combined orbital decompression and lower eyelid retraction correction surgery at the Second Hospital of Dalian Medical University from January 2017 to December 2018 were prospectively reviewed. We build a numerical model of biomechanics to analyze von Mises stress and displacement at the lower eyelid. The mean follow-up duration was 6 ± 2 months. The difference of mean exophthalmos was 5.16 ± 1.21 mm (t = 21.26, p = 4.479E-17 < 0.05). The difference of mean MRD2 was 1.9 ± 0.14 mm (t = 67.57, p = 6.751E-29 < 0.05). About 2 of 25 eyelids entropion recurred postoperatively; the overall success rate was 92%. The biomechanical analysis results reveal that the eyelid margin is given more stress and caused more displacement in East Asian ancestry under the same force of pressure. This study shows that the lower eyelid retraction with coexistent entropion is attributable to the unique anatomical features of patients of East Asians ancestry. We corrected the lower eyelid retraction and entropion during the orbital decompression operation. The results show that this method is safe and effective. It can simultaneously improve the symptoms of TED patients such as exophthalmos, lower eyelid retraction, and entropion, with minimal complications.

Inferolateral Transorbital Endoscopic Approach for Spheno-Orbital Meningiomas.

Spheno-orbital meningiomas (SOM) are slow growing tumors that often cause proptosis and visual deficits, due to direct compression of adjacent structures or hyperostosis of surrounding bones.Traditionally, these lesions are approached via a lateral transcranial route. Recent interest in mini-invasive surgery and endoscopy brought many authors to study different trans-nasal or transorbital approaches.The authors report a surgical case series with 3 patients with proptosis due to SOM who underwent surgery in our institution via an inferolateral trans-orbital endoscopic approach. The authors described our surgical technique and the authorsretrospectively reviewed the clinical and radiological outcomes of the patients.All 3 patients had an effective orbital decompression with improvement of the proptosis and pain relief. Histological examination was possible and no intraoperative nor postoperative complications were observed.Therefore, the authors consider inferolateral trans-orbital endoscopic approach as a feasible approach for lesions involving the lateral orbit compartment arising from middle cranial fossa or from orbit itself.

Ethnic variation in medial orbital wall anatomy and its implications for decompression surgery

BackgroundTo describe the inter-ethnic variation in medial orbital wall anatomy between Chinese, Malay, Indian and Caucasian subjects.MethodsSingle-centre, retrospective, Computed Tomography (CT)-based observational study. 20 subjects of each ethnicity, were matched for gender and laterality. We excluded subjects younger than 16 years and those with orbital pathology. OsiriX version 8.5.1 (Pixmeo., Switzerland) and DICOM image viewing software CARESTREAM Vue PACS (Carestream Health Inc., USA) were used to measure the ethmoidal sinus length, width and volume, medial orbital wall and floor angle and the relative position of the posterior ethmoid sinus to the posterior maxillary wall. Statistical analyses were performed using Statistical Package for Social Sciences version 25.0 (IBM, USA).ResultsThere were 12 males (60 %) in each group, with no significant difference in age (p = 0.334–0.994). The mean ethmoid sinus length in Chinese, Malay, Indian and Caucasian subjects, using the Chinese as reference, were 37.2, 36.9, 38.0 and 37.4mm, the mean width was 11.6, 10.5, 11.4 and 10.0mm (p = 0.020) and the mean ethmoid sinus volume were 3362, 3652, 3349 and 3898mm3 respectively. The mean medial orbital wall and floor angle was 135.0, 131.4, 131.0 and 136.8 degrees and the mean relative position of posterior ethmoid sinus to posterior maxillary wall were − 2.0, -0.2, -1.5 and 1.6mm (p = 0.003) respectively.ConclusionsNo inter-ethnic variation was found in decompressible ethmoid sinus volume. Caucasians had their posterior maxillary sinus wall anterior to their posterior ethmoidal walls unlike the Chinese, Malay and Indians. Awareness of ethnic variation is essential for safe orbital decompression.

Lateral Wall Implant as an Adjunct to Lateral Wall Orbital Decompression in Severe Thyroid Eye Disease.

To describe the use of a lateral wall implant as an adjunct in lateral orbital wall decompression in severe thyroid eye disease. This study is a retrospective review of 6 patients who underwent prior orbital decompression but had persistent proptosis. These patients underwent lateral wall decompression with adjunct lateral wall implant placement with a manually vaulted 0.6-mm polyethylene-coated titanium mesh implant. Data collection included: visual acuity, intraocular pressure, exophthalmometry, ocular motility, eyelid position, and complication rates. Eight orbits in 6 patients underwent maximal lateral wall decompression and reconstruction using the polyethylene-coated titanium implant. Four males and 2 females were included with ages ranging from 25 to 73 years. Visual acuity improved an average of 2.4 lines (range 0-5 lines). Intraocular pressure improved an average of 7.5 mm Hg (2-13 mm Hg). There was reduction of proptosis by 3.4 mm on average (1-7 mm). Upper eyelid retraction improved on average by 1.8 mm (0-5 mm). Horizontal eye movements improved by 11% on average (-3.1% to +25%). Excellent cosmesis was achieved with no visible temple deformity, trismus, conjunctival scarring, orbital hemorrhage, or vision loss. The amount of volume created in lateral wall decompression is limited by the amount of native bone present and the temporalis muscle. In severe or recalcitrant cases, the authors propose the placement of a lateral wall implant as an adjunct to laterally displace the temporalis muscle and create additional volume. This technique accomplishes further reduction of proptosis in patients who have undergone prior orbital decompression.

Proposing a surgical algorithm for graduated orbital decompression in patients with Graves\u2019 orbitopathy

PurposeTo determine the outcome after orbital decompression using a graduated technique, adapting the surgical technique according to individual patients’ disease characteristics.MethodsWe retrospectively examined the postoperative outcome in patients treated with a graduated balanced orbital decompression regarding reduction of proptosis, new onset diplopia and improvement in visual function. 542 patients (1018 orbits) were treated between 2012 and 2020 and included in the study. Clinical examinations including visual acuity, exophthalmometry (Hertel) and orthoptic evaluation were performed preoperatively and at minimum 6 weeks postoperatively. Mean follow-up was 22.9 weeks.ResultsMean proptosis values have significantly decreased after surgery (p < 0.01). In 83.3% of the patients Hertel measurement normalized (≤ 18 mm) after surgery, New onset diplopia within 20° of primary position occurred in 33.0% of patients, of whom 16.0% had preoperative double vision in secondary gaze. Patients suffering from dysthyroid optic neuropathy (DON) had a significant increase in visual acuity (p < 0.01).ConclusionWe demonstrated that individually adapted graduated orbital decompression successfully improves key disease parameters of Graves’ orbitopathy with low morbidity.

Therapeutic difference between orbital decompression and glucocorticoids administration as the first-line treatment for dysthyroid optic neuropathy: a systematic review.

To assess all available data to compare the efficacy of glucocorticoids treatment and orbital decompression for dysthyroid optic neuropathy (DON). PubMed, EMBASE, the Cochrane Library databases as well as other sources were searched by two independent reviewers followed by extensive hand-searching for the identification of relevant studies. The primary outcomes were the improvement in visual acuity and responder rate. Secondary outcomes were the proptosis reduction, change in diplopia, and clinical activity score (CAS). One randomized controlled trial, three retrospective case series and one prospective case series met the inclusion criteria. They were divided into intravenous high-dose glucocorticoids (ivGC) group and orbital decompression (OD) group. Both groups demonstrated improvement in visual acuity. In addition, the proportion of patients with improved vision in OD group was higher than that in ivGC group (P<0.001). Post-treatment proptosis reduction was also reported in both groups. Overall, weighted mean in proptosis reduction estimated at 1.64 and 5.45 mm in patients treated with ivGC and OD respectively. This study also presented results regarding pre-existing and new-onset diplopia. Apart from diplopia, a wide variety of minor and major complications were noted in 5 included studies. The most common complication in ivGC group and OD group was Cushing's syndrome and epistaxis respectively. The present systematic review shows that both glucocorticoids treatment and OD are effective in treating DON and OD may work better in improving visual acuity and reducing proptosis. However, high-quality, large-sample, controlled studies need to be performed in the future.

Use of computer-assisted surgery in the orbit

ABSTRACT Purpose To present the application of computer-assisted surgery (CAS) in pre-operative planning, intra-operative navigation, and post-operative assessment as an adjunct tool in orbital surgery. Methods An IRB-approved, retrospective review was performed to identify patients who had undergone orbital surgery by a single surgeon from July 2013 to December 2019 with attention to pre-operative virtual surgical planning, intra-operative navigation, and post-operative assessment. The reasons and methods of CAS use were classified. Results The use of computer-assisted technologies was identified in 91 cases out of 464 orbital surgeries (19.6%). This included 23 (25.3%) orbital decompression surgeries, 39 (42.9%) fracture repairs, and 25 (27.5%) orbital tumors. In all cases, pre-, intra-, and post-operative CAS allowed for increased operative efficiency and safety with good outcomes. Conclusions Use of CAS in orbital surgery can allow for complex radiographic analysis and in select cases is a great tool to add to the orbital surgeon’s armamentarium.

Acute Fulminant Mucormycosis Triggered by Covid 19 Infection in a Young Patient.

Covid 19 infection can result in various opportunistic infections. Altered immune response, associated comorbid conditions like diabetes, prolonged steroid and broad spectrum antibiotics usage with ICU interventions lead to increased chance of such superadded infections in covid 19 patients. Here we report a case of 31 year old male with covid 19 infection who had new onset Diabetes Mellitus, developed severe acute fulminant Mucormycosis during the treatment for covid 19 infection. He presented with severe headache, nasal obstruction and discharge, bilateral ophthalmoplegia and blindness with Cavernous Sinus Thrombosis. Patient underwent aggressive surgical debridement with frontal craniectomy, maxillectomy and right orbital evisceration and left endoscopic orbital decompression and judicious efforts to revert back the immunocompromised status with high dose of Liposomal amphotericin. Post operatively patient developed right temporal lobe abscess which was drained through Endonasal Endoscopic Trans Cavernous drainage of Temporal Lobe Abscess. Patient is in 2 months follow up, with bilateral blindness and tolerating oral feeds with improved left eye ophthalmoplegia. It is imperative to note that the rising trend of mucormycosis is there in Covid 19 infections and it should be dealt with high index of suspicion in high risk patients and early aggressive treatment can save the patient as the survival rate is not high in such infections.

Management outcomes of mucormycosis in COVID-19 patients: A preliminary report from a tertiary care hospital

BackgroundCoronavirus disease 2019 (COVID-19) continues to be a significant health problem worldwide. The unprecedented surge of mucormycosis in patients with COVID-19 is a new emerging challenge. Although a few studies documenting high incidence of mucormycosis in COVID -19 patients have recently emerged in literature, data pertaining to treatment outcomes in such cohorts is lacking. Here, we report our experience in management of mucormycosis in COVID-19 patients at our tertiary care centre. MethodThe clinical, imaging, histopathological and treatment data of 20 patients with mucormycosis (in setting of COVID-19) was analysed. Results35% and 65 % of cases developed mucormycosis in setting of active and recovered COVID-19 infections respectively. Diabetes mellitus was documented in 80% cases, with 55% demonstrating HbA1c >10%. Steroid was administered in 80% during COVID-19 illness. Imaging demonstrated paranasal sinus (PNS), orbital and intracranial extension in 100%, 55% and 20% patients respectively. All received amphotericin and underwent endoscopic debridement, 20% underwent orbital decompression and 5% maxillectomy with orbital exenteration. 6/20(30%) patients died (4 with rhino-orbito-cerebral disease, 1 with extensive orbito-maxillary involvement and 1 sino-nasal disease). All 6 patients received steroids and documented poor glycaemic control. ConclusionThe strong association of hyperglycemia and steroid intake with mucormycosis in COVID-19 cases warrants judicious use of corticosteroids and optimal glycaemic control. Our study highlights that good clinical outcome can be achieved in invasive mucormycosis provided prompt treatment is instituted with aggressive surgical debridement and antifungal medication.

Impact of additional intravenous methylprednisolone pulse therapy on the quality of life in patients with dysthyroid optic neuropathy

Introduction. Dysthyroid optic neuropathy (DON) is a severe complication of Graves’ orbitopathy (GO). Treatment of DON should involve immediate administration of intravenous methylprednisolone (ivMP) in very high doses. It is recommended to include additional 12 pulses of ivMP according to a weekly schedule as a further step of the treatment process. The purpose of this study was to evaluate the influence of a 12-week ivMP treatment on the quality of life (QoL) in DON patients. Material and Methods. A retrospective study was conducted on 6 patients (the tests involved 8 individual eyes) with DON and treated with ivMP in very high doses, followed by orbital decompression in one patient. All patients were qualified for additional treatment with ivMP in a 12-week protocol and completed the Polish version of the GOQoL questionnaire before and after the therapy. Visual acuity (VA) and diplopia were examined prior to the administration of ivMP pulses for DON, as well as before and after the additional ivMP treatment. Results. A minimal clinically important difference in QoL was observed in four patients at the end of the additional ivMP therapy. A significant increase in VA was observed following additional pulses of ivMP compared to the evaluation at the time of the DON diagnosis (p=0.04). Conclusions. Applying additional 12 pulses of ivMP following DON therapy may impact QoL. Performing QoL assessment throughout the entire therapy in patients with DON is particularly important in the clinical practice. Final evaluation of QoL should be performed after completing the entire therapeutic process, which involves surgical treatment to correct diplopia.

Extraocular muscle expansion after deep lateral orbital wall decompression: influence on proptosis reduction and its predictive factors.

To examine the relationship between extraocular muscle expansion and proptosis reduction (Δproptosis) in patients with thyroid eye disease who underwent deep lateral orbital wall decompression and to analyze the factors that contribute to extraocular muscle expansion. This retrospective, observational study included 133 sides from 77 patients with thyroid eye disease. The cross-sectional areas of the greater wing of the sphenoid bone (trigone), extraocular muscles, and superior ophthalmic vein were measured on computed tomographic images. Variables influencing Δproptosis were analyzed using multivariate linear regression analyses with stepwise variable selection. Predictive factors for the rate of postoperative increase in the cross-sectional extraocular muscle areas (Δextraocular muscle) were analyzed using the same statistical method. The amount of orbital fat removed (P < 0.001) and rate of Δlateral rectus muscle (P < 0.001) were positively and negatively correlated with Δproptosis, respectively (r = 0.425; adjusted r2 = 0.168; P < 0.001). The cross-sectional trigone area (P < 0.001) was positively correlated with the rate of Δlateral rectus muscle, whereas the preoperative cross-sectional lateral rectus muscle area (P < 0.001) and amount of orbital fat removed (P = 0.036) were negatively correlated with the rate of Δlateral rectus muscle (r = 0.551; adjusted r2 = 0.288; P < 0.001). Lateral rectus muscle expansion was negatively correlated with proptosis reduction and proved to be predictable before surgery. The results of this study will help predict proptosis reduction after deep lateral orbital wall decompression and to preoperatively plan additional orbital bony and fat decompression.

Factors Associated with Postoperative Strabismus by Endoscopic Orbital Decompression in Patients with Thyroid-associated Ophthalmopathy

Factors Associated with Postoperative Strabismus by Endoscopic Orbital Decompression in Patients with Thyroid-associated Ophthalmopathy

Endoscopic Endonasal versus Transcranial Optic Canal Decompression: A Morphometric, Cadaveric Study.

Introduction Decompression of the optic nerve within the optic canal is indicated for compressive visual decline. The two most common approaches utilized for optic canal decompression are a medial approach with an endoscopic endonasal approach and a lateral approach with a craniotomy. Our study is a cadaveric anatomical study comparing the length and circumference of the orbit decompressed via an endoscopic endonasal approach versus a frontotemporal craniotomy. Methods Five cadaveric specimens were utilized. Predissection computed tomography (CT) scans were performed on each specimen. On each specimen, a standard frontotemporal craniotomy with anterior clinoidectomy and superolateral orbital decompression was performed on one side and an endoscopic endonasal approach with medial wall decompression was performed on the contralateral side. Post-dissection CT scans were performed. An independent radiologist provided measurements of the length (mm) and circumference (degrees) of optic canal decompression bilaterally. Results The mean length of optic canal decompression for open and endoscopic approach was 13 mm (range 12-15 mm) and 12.4 mm (range 10-16 mm), respectively. The mean circumference of decompression for open and endoscopic approaches was 252.8 degrees (range 205-280 degrees) and 124.6 degrees (range 100-163 degrees), respectively. Conclusion The endoscopic endonasal and the transcranial approaches provide a similar length of optic canal decompression, but the transcranial approach leads to greater circumferential decompression. The endoscopic endonasal approach has the benefit of being minimally invasive, though. Ultimately, the surgical approach decision should be based on the location of the pathology and the surgeon's comfort.

Surgical management of the orbit in thyroid eye disease: lateral orbital decompression.

Lateral orbital wall decompression is one of many well established techniques available to surgeons in management of patients with clinically significant thyroid eye disease (TED). Several different surgical approaches have been described in the literature and are reviewed herein. Lateral orbital wall decompression remains a popular technique for surgical management of TED, with a recent American Society of Ophthalmic Plastic and Reconstructive Surgery survey showing that 22.6% of respondents preferred a single-wall procedure, with 36.8% of that subset preferring lateral wall decompression alone. Surgical techniques for lateral orbital wall decompression differ based on several steps, such as the incisional approach, whether to take an ab-interno versus ab-externo approach, and whether to remove orbital fat to achieve further decompression. In addition, technological advances have produced an array of tools available to the orbital surgeon to achieve efficient and accurate bone removal. Lateral orbital wall decompression for TED, despite being an older technique, remains a popular and well established procedure for orbital decompression. Though no randomized controlled clinical trial supports one decompression technique over another for TED, lateral orbital wall decompression offers many benefits such as its ease of access and visualization of the orbital space.

A Study on Maternal and Perinatal Outcome in Pregnant Women Presenting with First Trimester Vaginal Bleeding and Ultrasonographic Evaluation

This study is an analysis of five cases of orbital trauma causing proptosis, paralysis of extraocular muscles with or without associated visual failure. All the cases were treated by a ENT and Neurosurgical team. Either a frontal craniotomy or a lateral orbitotomy was performed. Plain X-rays of the skull and Computerised Tomography (C.T. Scanning) were the main investigations. Results were encouraging both functionally and cosmetically. Early diagnosis and an aggressive approach to orbital decompression can achieve good results

Volumetric Analysis and Clinical Outcome in 54 Patients with Retrobulbar Hematoma

Retrobulbar hematoma (RBH) is a rare but serious vision threatening emergency. We analyze the relationship between hematoma volume, visual impairment and outcome. Fifty-four patients with RBH receiving orbital decompression were retrospectively included. Volumetric analysis of RBH was performed by semi-automatic segmentation based on preoperative CT scans using ITK-SNAP software. Best corrected visual acuity (BCVA) measurements were obtained and correlated in 2 groups (no light perception (NLP), severe visual impairment) with the hematoma volume. NLP was documented preoperatively in 5/28 and postoperatively in 9/43 patients. Preoperative NLP was significantly associated with a larger hematoma volume (P=.03) and higher hematoma/orbital volume ratio (P=.03). Postoperative severe visual impairment showed significant associations with a larger hematoma volume (P=.02) as well as higher hematoma/orbital volume ratio (P=.02). Eyes with severe visual impairment and large hematoma volumes preoperatively are at high risk of permanent vision loss. Hematoma volume calculation might represent an additional prognostic parameter for visual outcome after RBH.