From the Department of Surgery, McMaster University; the Department of Ophthalmology and Vision Sciences, University of Toronto; and the Department of Plastic Surgery, Sunnybrook Health Sciences Hospital.
Plast Reconstr Surg. 2018 Aug;142(2):169e-178e. doi: 10.1097/PRS.0000000000004600.
Posttraumatic enophthalmos has debilitating functional consequences, resulting in restriction of ocular motility and diplopia. Surgical correction aims to restore the globe position and ultimately improve function. This study evaluates the functional outcome of posttraumatic enophthalmos repair.
Patients included in this study had posttraumatic enophthalmos and diplopia requiring enophthalmos repair. Diplopia was graded from 0 (no diplopia) to 4 (constant diplopia) based on the Functional Diplopia Grading Scale. Limitations of eye movements were recorded in the vertical, horizontal, and torsional directions. Data were gathered prospectively at preoperative assessment, postenophthalmos repair, and final follow-up.
Between 2002 and 2014, 41 patients fulfilled inclusion criteria. Substantial functional improvement, defined as a decrease of greater than or equal to 1 grade of diplopia, was achieved in 65.9 percent of patients (27 of 41) after all surgical interventions. Patients with residual diplopia (34 of 41) after enophthalmos surgery were managed with secondary strabismus surgery (10 of 34) and/or prism glasses (four of 34). After all interventions, vertical restrictions improved from -1.95 ± 1.13 to -1.06 ± 0.98. Horizontal restrictions improved from -0.88 ± 0.62 to 0.59 ± 0.6. Adequate clinical correction of enophthalmos to within 2 mm of the contralateral globe was achieved in 37 of 41.
This is the largest case series evaluating functional outcomes of patients undergoing posttraumatic delayed enophthalmos repair. A multidisciplinary care approach resulted in improved globe position and eye movement, and improvement of diplopia. Further studies with larger sample sizes are needed to better understand and treat this important and challenging problem.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
创伤后眼球内陷会导致严重的功能障碍，从而限制眼球运动并导致复视。手术矫正的目的是恢复眼球位置，最终改善功能。本研究评估了创伤后眼球内陷修复的功能结果。
本研究纳入了患有创伤后眼球内陷和需要修复眼球内陷的复视的患者。根据功能复视分级量表，将复视分为 0 级（无复视）至 4 级（持续复视）。记录眼球运动的垂直、水平和扭转方向的限制。数据在术前评估、眼球内陷修复后和最终随访时进行前瞻性收集。
在 2002 年至 2014 年间，有 41 例患者符合纳入标准。所有手术干预后，65.9%（27/41）的患者实现了显著的功能改善，定义为复视程度降低≥1 级。眼球内陷手术后仍有残余复视（34/41）的患者接受了二次斜视手术（34/34）和/或棱镜眼镜治疗（34/34）。所有干预后，垂直限制从-1.95±1.13 改善至-1.06±0.98。水平限制从-0.88±0.62 改善至 0.59±0.6。41 例中有 37 例达到了将眼球内陷矫正至与对侧眼球相差 2mm 以内的临床充分矫正。
这是评估创伤后迟发性眼球内陷修复患者功能结果的最大病例系列研究。多学科护理方法改善了眼球位置和眼球运动，并改善了复视。需要更大样本量的进一步研究来更好地理解和治疗这一重要且具有挑战性的问题。
临床问题/证据水平：治疗，IV。
