Analysis Of The Characteristics Of Diplopia Before And After Surgical Treatment Of Pediatric Orbital Blowout Fracture

Objective:To investigate and summarize clinical presentations and characteristics of diplopia in pediatric patients with orbital blowout fracture classified by age,to analyze causes of preoperative diplopia and influence factors of postoperative residual diplopia,and to clarify the general tendencies and rules of diplopia recovery by creating a recovery curveMethods and Materials:Clinical data of pediatric patients with orbital blowout fracture in Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine between January 2008 and January 2015 were retrospectively reviewed,including patients'age,gender,clinical presentations,orbital CT imaging data,surgical procedure,follow-up information.The causes of preoperative diplopia were analyzed by a comparison of clinical presentations and diplopia degrees in patients of different age groups.A Kaplan-Meier curve was created to clarify recovery of diplopia after surgical repair.Cox regression analysis was performed in the analysis of influence factors of postoperative residual diplopiaResults:139 pediatric patients(139 eyes)were enrolled in this study with an average age of 11.97±4.87 years old,ranging from 3 to 18 years.The average follow-up time was 17.68±11.30 months.Before surgery,a total of 135 patients presented with diplopia to different degrees,including 114 patients with Grade ? and Grade ?diplopia.Among 116 patients with preoperative restricted ocular mobility,only 4 of them didn't have diplopia.46 out of 67 patients with preoperative enophthalmos had presentations of Grade ? and Grade ? diplopia.Preoperative diplopia degrees were closely related to restricted ocular mobility(p=0.035)and enophthalmos(p=0.001)After surgery,none developed any severe complications of vision impairment or infection of implants.22 patients presented with different degrees of residual diplopia In patients with Trapdoor fracture,patients' age(p=0.045)and extraocular muscle swelling(p=0.011)were important factors related to postoperative residual diplopia,while age(p<0.001),interval time from injury to surgery(p<0.001)and extraocular muscle swelling(p=0.028)were relevant influence factors of postoperative residual diplopia in patients with non-Trapdoor fractureConclusions:The clinical presentations of orbital blowout fracture in children with different age groups are various.Younger children mainly present with diplopia and restricted ocular mobility to different degrees,while older patients have enophthalmos as their main clinical presentations.Restriction in ocular mobility is closely related to preoperative diplopia in children.Surgical treatment is a primary method to improve restriction in ocular mobility in pediatric patients with orbital blowout fracture,and early intervention is of great importance in the recovery of diplopia.Patients with younger age should be paid more attention to because they are more likely to develop longer recovery time and higher incidence of residual diplopia.Generally speaking,the recovery time of diplopia after surgical repair is approximately one year in children,much longer than that in adults.Therefore,younger patients should be encouraged to reinforce functional training of extraocular muscles within one year after surgery to reduce the possibilities of residual diplopia.