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Ahn, Park, and Chi: Using Computed Tomography: Predictive Factors for Recovery Time in Patients with Orbital Fracture with Diplopia
Original Article

Journal of the Korean Ophthalmological Society 2019; 60(6): 501-509.

Published online: 17 June 2019

DOI: https://doi.org/10.3341/jkos.2019.60.6.501

Using Computed Tomography: Predictive Factors for Recovery Time in Patients with Orbital Fracture with Diplopia

Jong Ho Ahn, MD, Su Jin Park, MD, Mi Jung Chi, MD, PhD

Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea.

Address reprint requests to Mi Jung Chi, MD, PhD. Department of Ophthalmology, Gachon University Gil Medical Center, #21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: 82-32-460-3364, Fax: 82-32-460-3358, cmj@gilhospital.com

Received 22 November 2018       Revised 14 February 2019       Accepted 18 May 2019

©2019 The Korean Ophthalmological Society

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 identify predictive factors for recovery time in patients with orbital fracture with diplopia through analysis of preoperative and postoperative computed tomography (CT) images and postoperative recovery time.

Methods

We retrospectively analyzed CT findings-preoperative: fracture size, type of fracture, fracture site, extraocular muscle (EOM) swelling, EOM and soft tissue injury, and the amount of soft tissue herniation; post-operative: degree of enophthalmos, and diplopia recovery period in 379 patients who underwent surgical treatment for orbital fracture between March 2006 and December 2015.

Results

The average postoperative follow-up period was 556.2 ± 59.5 days, and the mean duration of recovery was 23.9 ± 42.5 (range, 3–186) days. The recovery time of diplopia was significantly increased with the following preoperative CT findings: fracture size (small and medium < large) (p = 0.049), type of fracture (linear < hinge < comminuted, trap-door) (p < 0.01), fracture site (inferior < medial and both) (p < 0.01), EOM and soft tissue injury (prolapse and torsion, muscle entrapment, kinked muscle) (p < 0.01), and the amount of soft tissue herniation (small and medium < large) (p < 0.001). The mechanism of injury, sex, age, and the degree of enophthalmos were not related to the length of the diplopia recovery period.

Conclusions

The length of diplopia recovery could be predicted by CT findings.

Keywords: Computed tomography, Diplopia, Orbital fracture

Figures and Tables

Figure 1

The size and type of blowout fracture. The size of the orbital wall fracture classified into small (< 20%) (A), medium (B) and large (> 50%) (C). The type of the orbital wall fracture classified into linear (D), hinged (E), comminuted (F) and trapdoor (G).

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Figure 2

Extraocular muscle swelling. The measurement of extraocular muscles (white arrow, short axis; black arrow, long axis).

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Figure 3

Soft tissue herniation. Amount of soft tissue herniation classified into small (only soft tissue, small amount) (A), medium (only soft tissue, large amount) (B) and large (soft tissue with muscle, large amount) (C).

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Figure 4

Extraocular muscle and soft tissue injury. Extraocular muscle and soft tissue injury type classified into muscle prolapse without torsion (A), muscle torsion without prolapse (B), muscle prolapse with torsion (C), kinked muscle by bone (D), muscle entrapment (E) and soft tissue entrapment (F).

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Figure 5

Enophthalmos. Degree of enophthalmos (6 to 12 months after the surgery).

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Table 1

Demographics and clinical characteristics of patients

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Values are presented as mean ± standard deviation or number (%).

*Spearman correlation; †Mann-Whitney U test; ‡Kruskal-Wallis test.

Table 2

The relationship between diplopic period and pre-operative CT features of bone fracture

jkos-60-501-i002

Values are presented as mean ± standard deviation unless otherwise indicated.

CT = computed tomography.

*Kruskal-Wallis test, Ducan †<‡<§.

Table 3

The relationship between diplopic period and pre-operative CT features of EOM and soft tissue

jkos-60-501-i003

Values are presented as mean ± standard deviation unless otherwise indicated.

CT = computed tomography; EOM = extraocular muscle; S/L ratio = short axis length/long axis length ratio.

‡Kruskal-Wallis test, Ducan *<†<§; ΠSpearman correlation.

Table 4

The relationship between diplopic period and the degree of post-operative enophthalmos (6 to 12 months after the surgery)

jkos-60-501-i004

Values are presented as mean ± standard deviation unless otherwise indicated.

*Spearman correlation.

Table 5

Radiological characteristics of patients with persistent diplopia

jkos-60-501-i005

EOM = extraocular muscle; S/L ratio = short axis length/long axis length ratio; M = medial wall; I = inferior wall.

Notes

Conflicts of Interest The authors have no conflicts to disclose.

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