Can a Specific Computed Tomography-Based Assessment Predict the Ophthalmological Outcome in Pure Orbital Floor Blowout Fractures?

Abstract

The aim of this study was to determine the predictive value of a specific computed tomography (CT)-based assessment for the final functional ophthalmological outcome in pure orbital floor blowout fractures. Data of 34 consecutive patients with pure blowout fractures who had undergone a period of at least 6 months of medical and ophthalmological follow-up were analyzed. The following 3 CT scan-based parameters were included: area ratio of the fractured orbital floor (RF), maximum height of periorbital tissue herniation (MH), and a 4-grade muscular subscore (MSS) describing the inferior rectus muscle displacement relative to the orbital floor level. The orthoptic complications (diplopia, enophthalmos, and ocular motility restriction) were evaluated by an experienced strabologist. The CT parameters' predictive value was analyzed using receiver operating characteristic curves and area under the curve (AUC), logistic regression, and Spearman correlation.The RF had a significant predictive value for enophthalmos appearance (AUC ¼ 0.75, P ¼ 0.02), and MH for diplopia (AUC ¼ 0.80, P ¼ 0.03). Among patients with complications, the relevance of MSS and MH as well as the severity of vertical deviation were also clinically strongly associated (rho ¼ À0.52 and À0.56).Our study revealed the significantly predictive value of RF for occurrence of enophthalmos and of MH for diplopia persistence. Although statistically unable to predict the occurrence of ocular motility restriction, MH and MSS were clinically strongly correlated with the severity of ocular deviation limitations.

Are Inferior Rectus Muscle Displacement and the Fracture's Size Associated With Surgical Repair Decisions and Clinical Outcomes in Patients With Pure Blowout Orbital Fracture?

“…In 2016, we performed a preliminary study on 34 patients to determine the predictive power of fracture size, IRM displacement, and periorbital tissue herniation. 36 We found fracture size and periorbital tissue herniation to be predictors of enophthalmos and persistent annoying diplopia, respectively. No association could be established between IRM displacement and either enophthalmos or diplopia.…”

“…28,29 Others showed that the position and swelling of the inferior rectus muscle (IRM) in relation to the fracture were associated with persistent diplopia outcomes. [30][31][32][33][34][35][36][37][38][39][40] To date, only a few retrospective studies have reported specifically on the predictive value of the degree of displacement of the IRM into the maxillary sinus as assessed on CT scans for residual diplopia and/or enophthalmos. [30][31][32][33][34][35][36][37][38][39][40] However, no prospective studies have assessed the predictive value of displacement of the IRM into the maxillary sinus in determining the need for surgical treatment in BOFs and/or preoperative diplopia.…”

Does postoperative orbital volume predict postoperative globe malposition after blow-out fracture reconstruction? A 6-month clinical follow-up study

“…The fractured area is an important predictor for enophtalmos even in patients undergoing surgery [12]. It has been reported to be a more important predictor for GMP than preoperative enophtalmos [4, 16].…”

“…The finding that observable postoperative GMP occurs despite satisfactory surgery poses the question of whether surgical restoration is necessary in patients with minor symptoms or findings. Bruneau et al [12] showed in their study of 34 isolated orbital floor fractures that GMP and diplopia were not resolved with surgery. The final clinical outcome was not better in patients with surgery compared with patients who did not undergo surgery.…”

“…Orbital fat scar formation in the retrobulbar space and fat atrophy has been described [5, 9–11]. Furthermore, soft tissue changes and size of the primary fracture area have been shown to predict postoperative enophtalmos independent of surgery [12]. Thus, the clinical significance of postoperative volume change should be analyzed in more detail and compared with other fracture-related factors.…”