Predictors of Postoperative Diplopia Following Orbital Fracture Repair in Adults

Authors

Bashar Hassan, Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
Joshua Yoon, Department of Surgery, George Washington University, Washington, DC, USA.
Seray Er, University of Maryland School of Medicine, Baltimore, MD, USA.
Eric Resnick, University of Maryland School of Medicine, Baltimore, MD, USA.
Cynthia Yusuf, University of Maryland School of Medicine, Baltimore, MD, USA.
Fan Liang, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Robin Yang, Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Michael Grant, Division of Plastic and Reconstructive Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.

Document Type

Journal Article

Publication Date

10-10-2023

Journal

Plastic and reconstructive surgery

DOI

10.1097/PRS.0000000000011136

Abstract

PURPOSE: Postoperative diplopia is reported in up to 52% of orbital bone fracture (OBF) repair. Evidence on these risk factors is based on low-quality data, single-institution studies, and small sample sizes. Our study is the largest and first multi-center study to determine the predictors of postoperative diplopia following OBF repair. METHODS: We conducted a retrospective review of patients who underwent OBF repair at two centers from 2015 to 2019. Our primary outcome was the incidence or persistence of postoperative diplopia at least 2 weeks following OBF repair. Descriptive statistics were calculated. Multivariable logistic regression was performed to determine significant predictors of postoperative diplopia. RESULTS: Of 254 patients, the median (interquartile range [IQR]) age was 36.1 (27.8-50.7) years, and the median (IQR) follow-up was 79.5 (40.3-157.3) days. The most common postoperative ocular symptom was diplopia [n=51/254 (20.1%)]. Patients who had preoperative limited ocular motility or enophthalmos had adjusted odds ratio [aOR] (95% confidence interval [CI]) 2.33 (1.03-5.24) and 2.35 (1.06-5.24) the odds of developing postoperative diplopia, compared to patients who did not have these preoperative symptoms, respectively. Patients who had combined orbital floor and medial wall and moderate OBF (>2 cm2 defect or >3 mm displacement) on preoperative CT scan had aOR (95% CI) 2.16 (1.04-4.46) and 3.77 (1.44-9.83) the odds of developing postoperative diplopia, compared to patients without these preoperative CT findings, respectively. CONCLUSION: During primary assessment of the patient with OBF, preoperative ocular signs and symptoms, fracture severity, and location of OBF are key predictors of postoperative diplopia.

APA Citation

Hassan, Bashar; Yoon, Joshua; Er, Seray; Resnick, Eric; Yusuf, Cynthia; Liang, Fan; Yang, Robin; and Grant, Michael, "Predictors of Postoperative Diplopia Following Orbital Fracture Repair in Adults" (2023). GW Authored Works. Paper 3622.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3622

Department

School of Medicine and Health Sciences Resident Works