| Objective:To observe the disappearance time of diplopia in patients with orbital burst fractures and explore its related influencing factors.So as to explore ways to reduce the incidence of new diplopia and exacerbation of diplopia after surgery,to shorten the disappearance time of postoperative diplopia,and to provide a clinical reference for predicting the disappearance time and improvement of diplopia in patients with orbital burst fractures.Method:This study is a prospective study.From April 2018 to September 2019,a total of144 patients(144 eyes)who were diagnosed with orbital blowout fracture in the Second Hospital of Jilin University and were treated by the same surgeon for orbital fracture rehabilitation were included in the study.All patients were identified by CT scan for orbital fracture type,location,and extraocular muscle incarceration.All patients were subjected to best corrected visual acuity(BCVA),mydriatic fundus examination,intraocular pressure,visual fields,and visual evoked potential(VEP)),diplopia and synoptic examination,eye movement.Eye movement,diplopia and synoptic examination were also performed at 1 week,3 weeks,1 month,2 months,and 3 months after surgery.Orbital CT scanning was re-examined 3 weeks after the operation to evaluate the effect of the surgery.The situation,in which position and size of the implantable bone fragments were appropriate,the orbital tissue was completely reduced,and no intraocular tissue incarceration and hernias,was Considered surgically effective.Diplopia severity is graded using diplopia examination and synoptic examination.Eye movement,diplopia examination and synoptic examination were used to determine the nature of extraocular muscle damage.Postoperative follow-up until diplopia was completely disappearance.The bservation indicators of diplopia disappearance were the absence of diplopia,the diplopia and synapse examination confirmed the release of extraocular muscle dysfunction.This study counts the disappearance time of diplopia in weeks(w).SPSS 25.0 statistical analysis software was used to analyze the data.Results:Among 144 patients with orbital blowout fracture,there were 131 cases having diplopia after surgery,and the diplopia existence rate was 90.97%.After surgery,the diplopia in 5 cases was eliminated immediately,38 cases' diplopias were improved immediately,and the degree of diplopia was increased in 56 cases.And the incidence of aggravation of diplopia was 56.57%.45 patients,who had no diplopia before surgery,had diplopia after surgery,and the incidence of new diplopia was 82.22%.Patients were followed up to diplopia completely disappeared after surgery.99 cases with diplopia before surgery was significantly improved,among which 92 cases' diplopia completely disappeared,and the diplopia cancellation rate was 92.92%.7cases do not completely disappeared within 6 months after operation,of which 3cases were treated with extraocular muscles due to the diplopia was in front of the eye or reading the eye position,and the remaining 4 cases did not affect life and work without special treatment.37 cases who were diagnosed with Surgery-induced diplopia had recovered,and the mean time of diplopia disappearance was 8.36 ± 5.92 w.The time of diplopia disappearance in patients with orbital blowout fracture is significantly correlated with preoperative diplopia(P = 0.000,<0.05).Among the 92 patients with traumatic diplopia,there were 36 cases of restricted extraocular muscle injury,35 cases of paralytic injury,and 21 cases of restricted combined paralytic injury,and the average time of diplopia disappearance were 6.78 ± 5.65 w,8.66 ±5.63 w,and 10.60 ± 6.23 w,The time of diplopia disappearance was significantly related to the type of extraocular muscle injury(P = 0.012,<0.05).Among the 92 patients with diplopia with traumatic diplopia,the number of Diplopia Level I,Diplopia Level II,and Diplopia III were 12,43 and 37,the average time of diplopia elimination successively were 3.00 ± 2.80 w,7.52 ± 4.45 w,11.08 ± 6.71 w.The time of diplopia disappearance was significantly correlated with the diplopia grade(P =0.000,<0.05).Among 92 patients with traumatic diplopia,32 cases' fractures were located in the lower wall,26 cases were in the inner wall,and 34 cases were in the inner lower wall.The mean time of diplopia disappearance were 7.56 ± 6.72 w,8.64± 6.20 w,and 8.36 ± 4.90 w.There was no correlation between the recovery time of diplopia and the fracture site(P = 0.109,> 0.05).Among the 92 cases with traumatic diplopia,67 were operated early and 25 were operated late,and the mean time of diplopia disappearance respectively were 8.30 ± 5.73 w,and 8.30 ± 5.73 w.There was no correlation between recovery time of diplopia and the timing of surgery(P =0.986,> 0.05).Conclusion:The diplopia was significantly improved after the orbital fracture repair operation.Most patients' diplopia completely disappeared within 3 months after surgery,very few of patients need more than 6 months to eliminate the diplopia,and few patients have residual diplopia.Orbital Fracture Reconstruction can cause new diplopia,and it can disapeared faster than patients with diplopia before surgery.The nature of extraocular muscle injury is a factor that significantly affects the diplopia disappearance after surgery.The diplopia in patients with paralysis of extraocular muscles disappeared more slower than that of patients with restricted injury of extraocular muscles.Diplopia grade is also a factor that significantly affects the diplopia disappearance after surgery.The higher the diplopia grade is,the more slowly the diplopia disappeared.The orbital fracture site does not affect diplopia disappearance.There is no significant difference in the diplopia disappearance between patients with early surgery and patients with late surgery.Preoperative evaluation of the type of extraocular muscle injury,with or without diplopia,and the grade of diplopia have certain guiding significance for predicting the degree of diplopia improved and the time of diplopia disappearance. |
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