Abstract
Purpose :
Surgical protocols for the treatment of strabismus in patients with orbital fractures are rarely described in the literature. The purpose of this study was to describe the clinical features and surgical approaches used in patients with strabismus and persistent diplopia after orbital fracture repair, as well as in cases not requiring surgery for orbital fractures.
Methods :
A retrospective review was performed on patients with orbital fractures who received strabismus surgery between 2004 and 2016 at the Eye Hospital, of the Zhongshan Ophthalmic Center of Sun Yat-sen University, China. The following clinical data were obtained from the patients’ charts: nature of the fracture, age at surgery, pre-operative motor alignment, stereoacuity, surgical methods, surgical outcomes and complications. Deviations <10 PD of the horizontal angle and <5 PD of the vertical angle in the primary visual position were considered as comprising a successful outcome.
Results :
The records froma total of 29 patients (23 males and 6 females) with an average age of 32.4 years (range: 2 - 61 years) were included in this study. The strabismus was paralytic in 16 cases, restrictive in 2 cases and both paralytic and restrictive in 11 cases. While surgical methods employed were quite variable in each of these cases, all patients underwent either rectus recession or rectus recession plus resection. Pre-operative horizontal deviations of 32.79 ± 22.84 prism diopter (PD) were reduced to 6.69 ± 13.01PD (P<0.01), while pre-operative vertical deviations of 22.76 ± 17.66 PD were reduced to 6.59±7.98PD post-operatively (P<0.01), as determined at a minimum of at least a 6 month follow up period. Sixteen patients (55.2%) were considered as showing a successful outcome, while a surgical under-correction was observed in 44.8% of the cases. There were no surgical complications.
Conclusions :
The clinical manifestations of strabismus in patients with orbital fracture or after fracture repair are quite complex, often involving both paralytic and restrictive factors. While the surgical treatment for each case needs to be individualized, rectus muscle recession and resection appear to provide the most predictable, effective and stable outcome.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.