| 본문 : A 48-year old man, after being involved in a car accident, was brought to the emergency room presenting with severe right periorbital ecchymosis and edema. The patient’s unaided visual acuities were 4/20 and 20/20 in the right and left eye respectively, and intraocular pressures (IOP) were 7mmHg in the right eye and 10mmHg in the left eye. Anterior segment and fundus examination were unremarkable except with subconjunctival hemorrhage and superior White Without Pressure lesion. Computed tomography demonstrated fracture of the right superior, inferior, and medial orbital wall fracture with la large tissue herniation (Figure 1-A). One week later the patient had orbital wall reconstruction surgery, and the very night he complained of pain in the right eye. Postoperative computed tomography taken on the next day showed retrobulbar hematoma (Figure 1-B). Visual acuity of his right eye dropped to light perception, and IOP was 26mmHg. The Hertel exophthalmometry measurements were 27mm and 17mm in the right and left eye respectively. Removal of the hematoma was performed 2 days later as the size of the hematoma and patient’s symptoms showed no improvement. On his next visit at the hospital, a week after the hematoma removal, visual acuity of the right eye was no light perception (NPL) and IOP was 9mmHg. Fundus examination showed a cherry-red spot, milky-white lesion on macula, and multiple retinal hemorrhages; Optical coherence tomography of the macula revealed hyper-reflectivity and edema of the inner retinal layers indicating macular ischemia (Figure 2); Fluorescein angiography also demonstrated no blood flow to the macula. On the thirteenth postoperative day, his vision still remained NPL. |