Sashank K Reddy, Salih Colakoglu, Joshua S Yoon, Myan Bhoopalam, Shannath L Merbs, Paul N Manson, Michael P Grant
{"title":"外伤后持续性复视的治疗--患者分层和手术治疗的算法方法。","authors":"Sashank K Reddy, Salih Colakoglu, Joshua S Yoon, Myan Bhoopalam, Shannath L Merbs, Paul N Manson, Michael P Grant","doi":"10.1177/19433875221083084","DOIUrl":null,"url":null,"abstract":"<p><strong>Study design: </strong>Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma.</p><p><strong>Objective: </strong>Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes.</p><p><strong>Methods: </strong>A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005-2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified.</p><p><strong>Results: </strong>Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair.</p><p><strong>Conclusions: </strong>Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.</p>","PeriodicalId":46447,"journal":{"name":"Craniomaxillofacial Trauma & Reconstruction","volume":null,"pages":null},"PeriodicalIF":0.8000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201187/pdf/","citationCount":"0","resultStr":"{\"title\":\"Treatment of Persistent Post-traumatic Diplopia - An Algorithmic Approach to Patient Stratification and Operative Management.\",\"authors\":\"Sashank K Reddy, Salih Colakoglu, Joshua S Yoon, Myan Bhoopalam, Shannath L Merbs, Paul N Manson, Michael P Grant\",\"doi\":\"10.1177/19433875221083084\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Study design: </strong>Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma.</p><p><strong>Objective: </strong>Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes.</p><p><strong>Methods: </strong>A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005-2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified.</p><p><strong>Results: </strong>Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair.</p><p><strong>Conclusions: </strong>Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.</p>\",\"PeriodicalId\":46447,\"journal\":{\"name\":\"Craniomaxillofacial Trauma & Reconstruction\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.8000,\"publicationDate\":\"2023-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10201187/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Craniomaxillofacial Trauma & Reconstruction\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/19433875221083084\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/3/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q4\",\"JCRName\":\"DENTISTRY, ORAL SURGERY & MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Craniomaxillofacial Trauma & Reconstruction","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/19433875221083084","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/3/26 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"DENTISTRY, ORAL SURGERY & MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
研究设计:对曾接受眼眶外伤手术治疗而复视的患者进行眼眶再造手术结果的回顾性病历审查:我们的研究旨在回顾我们在处理曾接受过眼眶重建手术的复视患者的创伤后持续复视方面的经验,并提出一种新的患者分层算法,以预测更好的治疗效果:我们对约翰霍普金斯医院威尔默眼科研究所(Wilmer Eye Institute)和马里兰大学医学中心(University of Maryland Medical Center)2005-2020年间接受复视矫正眼眶手术的成年患者进行了回顾性病历审查。限制性斜视是通过兰卡斯特红-绿测试、计算机断层扫描和/或强迫抽吸来确定的。眼球位置通过计算机断层扫描进行评估。根据研究标准,确定了17名需要手术干预的患者:结果:14 名患者的眼球位置不正,11 名患者的局限性斜视。在这组选定的患者中,85.7%的球状体位置不正患者复视有所改善,90.1%的限制性斜视患者复视有所改善。一名患者在眼眶修复术后又接受了斜视手术:结论:对于曾接受过眼眶重建手术的患者来说,外伤后复视的治疗成功率很高。手术治疗的适应症包括:(1)眼球位置不正;(2)局限性斜视。高分辨率计算机断层扫描和兰卡斯特红-绿测试可将这些病因与其他不太可能从眼眶手术中获益的病因区分开来。
Treatment of Persistent Post-traumatic Diplopia - An Algorithmic Approach to Patient Stratification and Operative Management.
Study design: Retrospective chart review of revisional orbital surgery outcomes in patients with diplopia from prior operative treatment of orbital trauma.
Objective: Our study seeks to review our experience with management of persistent post-traumatic diplopia in patients with previous orbital reconstruction and present a novel patient stratification algorithm predictive of improved outcomes.
Methods: A retrospective chart review was performed on adult patients at Wilmer Eye Institute at Johns Hopkins Hospital and at the University of Maryland Medical Center who underwent revisional orbital surgery for correction of diplopia for the years 2005-2020. Restrictive strabismus was determined by Lancaster red-green testing coupled with computed tomography and/or forced duction. Globe position was assessed by computed tomography. Seventeen patients requiring operative intervention according to study criteria were identified.
Results: Globe malposition affected fourteen patients and restrictive strabismus affected eleven patients. In this select group, improvement in diplopia occurred in 85.7% of cases with globe malposition and in 90.1% of cases with restrictive strabismus. One patient underwent additional strabismus surgery subsequent to orbital repair.
Conclusions: Post-traumatic diplopia in patients with prior orbital reconstruction can be successfully managed in appropriate patients with a high degree of success. Indications for surgical management include (1) globe malposition and (2) restrictive strabismus. High resolution computer tomography and Lancaster red-green testing discriminate these from other causes that are unlikely to benefit from orbital surgery.