| Objective:To analyze the effect of orbital floor and medial wall fracture repair on pupil size and central position displacement by comparing the changes of pupil size and central position between the surgical eye and the control eye before and after operation in photopic and mesopic condition,providing a reference for clinical orbital fracture repair.Methods:A total of 61 cases(61 eyes)meeting the inclusion criteria were selected from 150 patients undergoing orbital floor and medial wall fracture repair in our hospital from September 2019 to October 2021,and they were divided into orbital floor group(n=25)and orbital medial wall group(n=36).The causes,types and postoperative results of orbital fracture were analyzed.All patients were followed up for 3 months.Comparative analysis of the changes of pupil size and postoperative pupil size in the preoperative control and surgical eyes between the two groups,and the deviation of the Xaxis and Y-axis under different light conditions.Results:1.Clinical data:The causes of orbital fracture were fighting and brawling 38%(23 c ases),falls and falls 20%(12 cases),car accidents 30%(23 cases)(inclu ding cycli ng injuries),trauma 12%(7 cases).Type of orbital fracture: It was divided into 41%(25)orbital floor fra ctures and medial wall fracture in 59%(36 cases).2.Postoperative resultsPupil size changes in the preoperative control eyes and surgical eyes in the two groups: pupil size changes in the orbital floor group under photopic and mesopic environment the 2.93±0.41 mm of the operating eye in photopic environment,the 2.90±0.25 mm was in the control eyes;4.88±0.46 mm under photopic environment,and 4.89±0.59 mm in control eye.Changes of pupil size in the medial wall group under photopic and mesopic environment:2.97±0.35 mm in surgical eyes under photopic and the 3.00±0.43 mm in the control eyes,5.12±0.55 mm pupil size of operated eyes in mesopic condition,the 5.18±0.56 mm in the control eyes.There was no statistical difference in the pupil size change between the two groups(P> 0.05).The changes of pupil size in the two groups after surgery were compared with that before surgery: the pupil size of the orbital floor group increased by8.4%±8.0%(P < 0.001),and that of the control eye increased by 8.0%±7.2%(P <0.05),pupil size in mesopic conditions was consistent with the above results.Pupil size of surgical eyes and control eyes in the medial wall group(photopic condition: operating eye-0.02±0.16 mm,control eye-0.04±0.14mm;mesopic condition: operating eye-0.02±0.22 mm,control eye-0.05±0.23 mm.)No statistical difference(P> 0.05).The degree of preoperative pupil center deviation to X-axis and Y-axis in two groups under different light conditions:surgical eyes in the orbital floor group offset-0.06±0.09 mm to X-axis under photopic condition,control-0.05±0.09 mm,under mesopic condition surgical eye-0.12±0.10 mm,control eye 0.02±0.12 mm.The surgical eye was offset by 0.03±0.13 mm to the Y-axis under photopic condition,and the control eye-0.02±0.15 mm,0.01±0.12 mm in operated eyes under mesopic condition,control eyes-0.07±0.10 mm.Change of pupil center in medial wall group: surgical eye offset-0.06 ±0.13 mm to X-axis under photopic condition,control eye-0.05±0.11mm;offset-0.11± 0.12 mm under mesopic condition,control eye-0.04± 0.12 mm.Surgical eye offset-0.01 ± 0.11 mm in the Y-axis under mesopic condition,-0.05 ±0.11 in the control eye;0.04 ± 0.14 mm under mesopic condition,and 0.00 ±0.15 mm in the control eye.None of them were statistically different(P> 0.05).There was no statistical difference in the central pupil deviation of the X-axis and the Y-axis in the orbital floor group(P> 0.05).The slight displacement of the surgical eye pupil center to the X axis in 58.3% of patients in the medial wall group under mesopic condition,average horizontal offset,0.03±0.02mm(0.01–0.06mm)with a statistical difference(P <0.05).However,there was no statistical difference in the deviation of the Y-axis(P> 0.05).Comparing the degree of pupil central displacement between the two groups,the orbital wall group was slightly greater than that in the medial wall group.However,there was no statistical difference(P=0.17 in photopic condition,P=0.07 in mesopic condition).Conclusion:1.Compared with the preoperative pupil size,The pupils were dilated in the surgical and control eyes after orbital blowout fracture repair,and the pupil size changes were larger than those in the medial wall group.It can be used as an evaluation of the visual acuity changes after the repair of the orbital wall fractures.2.In comparison with the preoperative pupil center,the pupil center of the eye for medial wall fracture repair shifted along the X-axis to the nasal side under mesopic condition.It can be used as a reference index to assess the visual quality and prognosis after an orbital fracture. |
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