Lentskevich Marina A, Nguyen Alvin, Choudhary Akriti, Obaid Oday, Purnell Chad A
From the University of Illinois at Chicago College of Medicine.
Division of Plastic, Reconstructive, and Cosmetic Surgery, University of Illinois at Chicago.
Plast Reconstr Surg. 2025 Feb 1;155(2):402e-413e. doi: 10.1097/PRS.0000000000011609. Epub 2024 Jun 28.
Enophthalmos is a surgical indication for orbital fracture repair. However, guidelines to predict enophthalmos in orbital fractures are ambiguous. The authors systematically reviewed the existing literature on using computed tomographic findings to establish objective metrics to predict enophthalmos in asymptomatic patients during initial trauma work-up.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. PubMed and Embase were used to identify studies of interest. The Quality in Prognosis Studies tool was used for risk of bias assessment. Random-effects model meta-analyses of orbital volume change and fracture area values were completed. Regression analyses were performed to determine thresholds that predicted 2 mm of enophthalmos.
Of the initial 2236 abstracts, 36 met inclusion criteria. Thirty retrospective studies evaluated a total of 2851 patients, and 6 prospective studies evaluated 211 patients. All 36 studies had predominantly low risk of bias. Predictors of enophthalmos assessed were orbital volume change (21 articles), fracture surface area (13 articles), inferior rectus muscle displacements (7 articles), and fracture location (4 articles). Studies reporting on orbital volume change offered values ranging from 0.69 to 4.26 cm 3 . Fracture area predictor values ranged from 1.50 to 3.38 cm 2 . Meta-analyses confirmed the validity of both predictors. Pooled regression analyses demonstrated that 3.33 cm 3 of orbital volume increase or fracture area of 3.12 cm 2 were predictors of 2 mm of enophthalmos.
Both orbital volume change and fracture area measured on computed tomographic scan are good predictors of late posttraumatic enophthalmos. Pooled data indicate that 3.12 cm 2 of fracture area or 3.33 cm 3 of orbital volume increase is predictive of enophthalmos.
眼球内陷是眼眶骨折修复的手术指征。然而，预测眼眶骨折后眼球内陷的指南尚不明确。作者系统回顾了现有文献，探讨如何利用计算机断层扫描结果建立客观指标，以预测无症状患者在初次创伤检查时发生眼球内陷的情况。
遵循系统评价和Meta分析的首选报告项目指南。通过PubMed和Embase检索相关研究。使用预 后研究质量工具进行偏倚风险评估。完成眼眶容积变化和骨折面积值的随机效应模型Meta分析。进行回归分析以确定预测眼球内陷2毫米的阈值。
最初检索到的2236篇摘要中，36篇符合纳入标准。30项回顾性研究共评估了2851例患者，6项前瞻性研究评估了211例患者。所有36项研究的偏倚风险大多较低。评估的眼球内陷预测因素包括眼眶容积变化（21篇文章）、骨折表面积（13篇文章）、下直肌移位（7篇文章）和骨折部位（4篇文章）。报告眼眶容积变化的研究给出的值在0.69至4.26立方厘米之间。骨折面积预测值在1.50至3.38平方厘米之间。Meta分析证实了这两个预测因素的有效性。汇总回归分析表明，眼眶容积增加3.33立方厘米或骨折面积3.12平方厘米是眼球内陷2毫米的预测因素。
计算机断层扫描测量的眼眶容积变化和骨折面积都是创伤后晚期眼球内陷的良好预测指标。汇总数据表明，骨折面积3.12平方厘米或眼眶容积增加3.33立方厘米可预测眼球内陷。
