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Liza M Cohen, Michael K Yoon; Management of orbital fractures: A survey of common practices among oculoplastic surgeons. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5141.
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© ARVO (1962-2015); The Authors (2016-present)
Although commonalities exist in the management of orbital fractures by oculoplastic surgeons, there are differences in various aspects of management among surgeons. The purpose of this study was to analyze individual oculoplastic surgeon preferences in the management of orbital fractures and identify practice patterns.
An anonymous 17-question multiple-choice web-based survey was distributed to all members of the American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) using the society’s email database. Questions included demographic information and information regarding pre-operative, intraoperative, and post-operative management of orbital fractures.
Of 590 email requests sent to ASOPRS members, 222 surveys were completed and analyzed for a response rate of 37.6%. The most important factors influencing a surgeon’s decision to operate were motility restriction, enophthalmos, and diplopia at two weeks, as 95.9%, 87.0%, and 83.7% of respondents, respectively, indicated very strong or strong influence (Figure 1). For most surgeons (61.2%), the preferred time from injury to surgical intervention was 8-14 days. The majority (94.0%) of surgeons prefer a transconjunctival approach to orbital floor fracture repair compared to other approaches. There was variability in the preference of orbital implant; roughly half (54.9%) of surgeons prefer to use a porous versus non-porous implant. The most common preferred implants were nylon (31.6%), porous polyethylene (27.9%), and porous polyethylene + titanium (25.1%) (Figure 2). The vast majority of surgeons rarely or never use 3D intraoperative navigation (e.g. BrainLab, FUSION) (97.2%) nor intraoperative CT imaging (92.2%) for isolated orbital fracture repair. Only 5.5% perform routine post-operative imaging. Most surgeons follow-up orbital fracture patients for 1-3 months (46.1%) or 4-6 months (31.8%).
This survey identifies areas of consensus and disparity in the management of orbital fractures among oculoplastic surgeons. This information may advance our current understanding of the standard of care in the management of patients with orbital fractures.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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