Predictors of Postoperative Diplopia Following Orbital Fracture Repair in Adults.

PURPOSE: Postoperative diplopia is reported in up to 52% of orbital bone fracture (OBF) repair. Evidence on these risk factors is based on low-quality data, single-institution studies, and small sample sizes. Our study is the largest and first multi-center study to determine the predictors of postoperative diplopia following OBF repair.

METHODS: We conducted a retrospective review of patients who underwent OBF repair at two centers from 2015 to 2019. Our primary outcome was the incidence or persistence of postoperative diplopia at least 2 weeks following OBF repair. Descriptive statistics were calculated. Multivariable logistic regression was performed to determine significant predictors of postoperative diplopia.

RESULTS: Of 254 patients, the median (interquartile range [IQR]) age was 36.1 (27.8-50.7) years, and the median (IQR) follow-up was 79.5 (40.3-157.3) days. The most common postoperative ocular symptom was diplopia [n=51/254 (20.1%)]. Patients who had preoperative limited ocular motility or enophthalmos had adjusted odds ratio [aOR] (95% confidence interval [CI]) 2.33 (1.03-5.24) and 2.35 (1.06-5.24) the odds of developing postoperative diplopia, compared to patients who did not have these preoperative symptoms, respectively. Patients who had combined orbital floor and medial wall and moderate OBF (>2 cm2 defect or >3 mm displacement) on preoperative CT scan had aOR (95% CI) 2.16 (1.04-4.46) and 3.77 (1.44-9.83) the odds of developing postoperative diplopia, compared to patients without these preoperative CT findings, respectively.

CONCLUSION: During primary assessment of the patient with OBF, preoperative ocular signs and symptoms, fracture severity, and location of OBF are key predictors of postoperative diplopia.