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Clarissa Cheng, Llewellyn Lee; Predictors and Outcomes of Orbital Floor Fractures requiring Surgical repair. Invest. Ophthalmol. Vis. Sci. 2013;54(15):5341.
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To correlate the presence of enophthalmos, diplopia, fracture extent and muscle entrapment in orbital floor fractures with clinical outcome of surgical repair.
This was a retrospective review of consecutive cases of orbital floor fractures that underwent orbital floor repair between January 2000 to June 2009 from the Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. Significant enophthalmos (defined as greater than 2mm on Hertel’s exophthalmometer), significant diplopia (defined as objective diplopia within 30 degrees of primary gaze on binocular single vision test), extensive fracture (defined as greater than 50% on computer tomography) and muscle entrapment (examined intra-operatively) were analyzed at presentation, 1 week and 6 months post-repair, and correlated with surgical success. Surgical success was defined as no significant enophthalmos and no significant diplopia post-operation. Fisher exact test and McNemar test were used to analyze the results.
Fifty-nine patients were included in this study. Presence of significant enophthalmos pre-operatively was associated with significant enophthalmos at 1 week (p=0.04) and 6 months (p=0.001) post-operatively. Presence of significant diplopia pre-operatively and muscle entrapment were not associated with significant diplopia at 1 week and 6 months post-operatively. Extensive fracture was also not associated with significant clinical enophthalmos or presence of diplopia after surgical repair. Muscle entrapment was significantly associated surgical success at 6 months (p=0.03). Significant enophthalmos, significant diplopia and extensive fracture were not associated with surgical success at 6 months. Race, laterality and mechanism of injury were also not associated with surgical success.
Significant enophthalmos, diplopia and extensive fracture do not appear to influence surgical success at 6 months. Patient with muscle entrapment at presentation are more likely to have their symptoms and findings improved after surgical repair. Orbital floor fracture repair offers good clinical outcome in patients with orbital floor fractures, even in the presence of significant enophthalmos, diplopia, extensive fracture and muscle entrapment.
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