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Introduction of a Novel Method to Predict Final Globe and Eyelid Position After Orbital Surgery
Irene A. Chang, BA, Michael Wells, M.Eng, Anand R. Kumar, MD, Edward H. Davidson, MD
University Hospitals, Case Western Reserve University School of Medicine
2020-02-08
Presenter: Irene A Chang
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
Director Name: Anand Kumar
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction
Postoperative edema masks outcome in orbital trauma surgery. This study aims to establish a novel standardized coefficient to accurately predict the final globe and lid position.
Methods
Three dimensional photography was performed on patients undergoing orbital floor fracture repair. Images of each patient were taken pre-operatively and at two post-operative intervals and analyzed using the VECTRA imaging software. First and second postoperative images were superimposed onto the baseline image. A region of interest was defined by the lateral canthus, radix, subnasale, and intersection of lateral canthus and subnasale. Edema coefficients were defined by the volume and maximum distance difference between postoperative and baseline image as a ratio of the affected to unaffected side. The marginal reflex distance 1 (MRD1), palpebral fissure height (PFH), and globe projection (each corrected to the unaffected side) were measured and correlated with the edema coefficients and Pearson's r was used to determine significance.
Results
Maximum distance edema coefficient (Post-Op 1 mean 0.91, range 0.74-1.12; Post-Op 2 1.07, 0.77-1.38) was correlated with PFH (0.97, 0.80-1.13; 1.20, 0.95-1.60) (r=-0.7756, p=0.00069); globe projection (1.25, 1.17-1.34; 1.04, 0.82-1.26) (r=-0.8615, p=0.000038); and MRD1 (0.91, 0.74-1.12; 0.97, 0.77-1.38) (r=0.2611, p=0.347241). Volume edema coefficient (1.23, 0.31-2.89; 0.51, 0.41-0.67) was correlated with PFH (r=-0.4521, p=0.090741), globe position (r= 0.3381, p=0.217741) and MRD1 (r=-0.3008, p=0.277317).
Conclusion
A standardized edema coefficient can be used to predict final globe and lid position after orbital trauma surgery. Palpebral fissure height can be used as a simple clinical surrogate to determine final globe position.
