Compressive optic neuropathy after use of oxidized regenerated cellulose in orbital surgery - Review of complications, prophylaxis, and treatment

Purpose: We report 2 cases of compressive optic neuropathy after use of oxidized regenerated cellulose (ORC) in orbital surgery. To our knowledge, no complications have been reported previously after use of this material in orbital surgery. We also review the complications related to its retention at operative sites outside the orbit and recommend precautions to avoid them. Design: Retrospective interventional case reports. Participants: Two patients with compressive optic neuropathy after use of ORC in orbital surgery. Methods: Case reports from 2 different clinics and review of the English scientific literature. Main Outcome Measures: Best-corrected visual acuity, extraocular motility, proptosis, and chemosis. Results: One patient underwent orbital exploration and biopsy of an orbital tumor, and the second had repair of an orbital floor fracture. Postoperatively, both presented with chemosis, ophthalmoplegia, and progressive loss of vision. Orbital imaging revealed a retrobulbar soft-tissue density compatible with hematoma. Repeat orbital exploration revealed the soft-tissue mass to be swollen ORC. Conclusions: Retained intraorbital ORC may cause a compartment syndrome and should be suspected in postoperative patients with orbital symptoms. When ORC is used around the optic nerve, it should be removed after hemostasis is achieved.