Journal List > J Korean Ophthalmol Soc > v.58(7) > 1010804

TOOLS
Choi, Kim, Huh, Kim, and Seo: The Effect of Intraoperative Exophthalmometric Values on Enophthalmos Correction in Inferior Orbital Wall Reconstruction
Original Article

Journal of the Korean Ophthalmological Society 2017; 58(7): 769-775.

Published online: 14 July 2017

DOI: https://doi.org/10.3341/jkos.2017.58.7.769

The Effect of Intraoperative Exophthalmometric Values on Enophthalmos Correction in Inferior Orbital Wall Reconstruction

Yu-Jin Choi, MD1, Ji Hye Kim, MD1, Hyoun Do Huh, MD2, Seong Jae Kim, MD, PhD1, 3, Seong Wook Seo, MD, PhD1, 3

1Department of Ophthalmology, Gyeongsang National University, School of Medicine, Jinju, Korea.

2Department of Ophthalmology, Gyeongsang National University Changwon Hospital, Changwon, Korea.

3Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea.

Address reprint requests to Seong Wook Seo, MD, PhD. Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea. Tel: 82-55-750-8171, Fax: 82-55-758-4158, stramast@naver.com

Received 30 March 2017       Revised 31 May 2017       Accepted 22 June 2017

©2017 The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To measure the enophthalmos corrective effect after inferior orbital wall reconstruction, we compared preoperative and intraoperative exophthalmometric values with postoperative exophthalmometric values.

Methods

From January 2014 to April 2016, 60 eyes of 60 patients who underwent surgery for inferior orbital wall fracture were included. In Group 1, the exophthalmometric value was measured before surgery, during the operation, and 6 months after surgery using the Naugle exophthalmometer. In Group 2, the value was measured before surgery and 6 months after surgery using the Hertel exophthalmometer. The thickness of implants was determined by preoperative exophthalmometric values and overcorrection of 0.5 mm was performed in Group 1 patients with relatively large fractures.

Results

The mean age of the patients was 32.4 years in Group 1 and 34.3 years in Group 2. The mean duration between injury and surgery was 4.2 weeks in Group 1 and 2.3 weeks in Group 2. There was no statistically significant difference between preoperative exophthalmometric values in Group 1 (−1.78 ± 0.31 mm) and Group 2 (−1.81 ± 0.26 mm), but postoperative exophthalmometric values between Group 1 (−0.25 ± 0.78 mm) and Group 2 (−0.53 ± 0.46 mm) were statistically different (p = 0.034).

Conclusions

The exophthalmometric values and wall fracture size are important factors for determining implant thickness of inferior orbital wall reconstruction. Intraoperative measurement of exophthalmometric values should be considered in inferior orbital wall reconstruction for enophthalmos correction.

Keywords: Enophthalmos, Exophthalmometer, Inferior orbital wall fracture, Intraoperative exophthalmometric values

Figures and Tables

Figure 1

Photographs of measuring exophthalmometric values, using Naugle exophthalmometers. (A) Preoperative and postoperative measurement. (B) Intraoperative measurement.

jkos-58-769-g001
Figure 2

Three-dimensional computed tomography scan of the orbits (sagittal view). (A) Fracture size <2 cm. (B) Fracture size ≥2 cm.

jkos-58-769-g002
Table 1

Distribution of age and sex

jkos-58-769-i001

Values are presented as mean ± SD unless otherwise indicated.

Table 2

Distribution of preopreative enophthalmos

jkos-58-769-i002

Values are presented as n (%).

Table 3

Distribution of difference of exophthalmometric scales after implant insertion between normal eye and involved eye

jkos-58-769-i003

Values are presented as n (%).

Table 4

Distribution of difference of exophthalmometric scales between normal eye and involved eye

jkos-58-769-i004

Values are presented as n (%).

Table 5

Change of exophthalmometric scales between Group 1 and Group 2

jkos-58-769-i005

Values are presented as mean ± SD unless otherwise indicated.

*Subtraction of preoperative from postoperative exophthalmometric scales; †p < 0.05 (Independent t-test).

Table 6

Postoperative complication

jkos-58-769-i006

Values are presented as n (%).

Notes

Conflicts of Interest The authors have no conflicts to disclose.

References

1. Hazani R, Yaremchuk M. Correction of posttraumatic enophthalmos. Arch Plast Surg. 2012; 39:11–17.
2. Kim SY, Moon SH, Jang JW. Factors which influence postoperative enophthalmos in inferior orbital wall fractures. J Korean Ophthalmol Soc. 2003; 44:1489–1495.
3. Manson PN, Grivas A, Rosenbaum A, et al. Studies on enophthalmos: II. The measurement of orbital injuries and their treatment by quantitative computed tomography. Plast Reconstr Surg. 1986; 77:203–214.
4. Lee SJ, Park KS. Relationship between preoperative clinical features and postoperative recovery of ocular motility restriction in blow-out fractures. J Korean Ophthalmol Soc. 2001; 42:1202–1209.
5. Hwang JH, Kwak MS. Residual diplopia and enophthalmos after reconstruction of orbital wall fractures. J Korean Ophthalmol Soc. 2003; 44:1959–1965.
6. Kim IJ, Lee C, Cho JH. Analysis of persistent diplopia and enophthalmos after surgical repair of blower fracture. J Korean Ophthalmol Soc. 2003; 44:2204–2212.
7. Yamashita M, Daizo H, Yamashita A, et al. Correction of late posttraumatic enophthalmos using an antral balloon. J Craniofac Surg. 2015; 26:1365–1369.
8. Kim JS, Lee BW, Scawn RL, et al. Secondary orbital reconstruction in patients with prior orbital fracture repair. Ophthal Plast Reconstr Surg. 2016; 32:447–451.
9. Clauser L, Galiè M, Pagliaro F, Tieghi R. Posttraumatic enophthalmos: etiology, principles of reconstruction, and correction. J Craniofac Surg. 2008; 19:351–359.
10. Kim YH, Jung DW, Kim TG, et al. Correction of orbital wall fracture close to the optic canal using computer-assisted navigation surgery. J Craniofac Surg. 2013; 24:1118–1122.
11. McNichols CH, Hatef DA, Thornton JF, et al. A paradigm shift in correcting medial orbital fracture related enophthalmos: volumetric augmentation through a lateral approach. J Craniofac Surg. 2012; 23:762–766.
12. Dal Canto AJ, Linberg JV. Comparison of orbital fracture repair performed within 14 days versus 15 to 29 days after trauma. Ophthal Plast Reconstr Surg. 2008; 24:437–443.
13. Beigi B, Khandwala M, Gupta D. Management of pure orbital floor fractures: a proposed protocol to prevent unnecessary or early surgery. Orbit. 2014; 33:336–342.
14. Lee MS, Lew H, Lee SY. The results of delayed repair for orbital wall fracture. J Korean Ophthalmol Soc. 1998; 39:1049–1054.
15. Jang KH, Kim NJ, Choung HK, Khwarg SI. Orbital wall fracture repair: the results of early and delayed surgery. J Korean Ophthalmol Soc. 2016; 57:181–187.
16. Hwang JH, Lee SY, Kim SJ. Comparison of reproducibility between exophthalmometer reading measured with Hertel and Naugle exophthalmometer. J Korean Ophthalmol Soc. 1999; 40:293–298.
17. Kim BJ, Kim YD. Porous polyethylene (Medpor(R)) channel implants in orbital fracture repairs. J Korean Ophthalmol Soc. 2002; 43:1238–1249.
18. Jeon C, Shin JH, Woo KI, Kim YD. Porous polyethylene/titanium implants in the treatment of large orbital fractures. J Korean Ophthalmol Soc. 2009; 50:1133–1140.
TOOLS
Similar articles