Does vertical incomitance predict the diplopia outcome in orbital fracture patients? A prospective study of 188 patients

Publication date: Available online 5 December 2018

Source: Journal of Cranio-Maxillofacial Surgery

Author(s): F. Bianchi, R. De Haller, H. Steffen, D.S. Courvoisier, P. Scolozzi

Abstract

Objective

To determine the predictive value of vertical incomitance for diplopia outcome in orbital fracture patients.

Patients and Methods

A prospective cohort study composed of patients with orbital fractures was designed. The predictor variable was vertical incomitance, and the primary outcome variable was diplopia. Incomitance was calculated in prism diopters (Δ) as the difference of the maximum absolute deviation between the upper and lower three gaze directions. Standard statistics for patient characteristics, the Fisher exact test for categorical variables and the Wilcoxon rank sum test for continuous variables were computed.

Results

The sample was composed of 188 patients grouped as follows: non-operated (n=124) and operated (n=64). Fifty-one patients showed vertical incomitance of whom10 (19.6%) had persistent diplopia at the 1-year follow-up. The mean incomitance was 9.6Δ in the diplopia group versus 2Δ in the non diplopia group (OR=1.13; p<0.001). There was a statistically significant association between vertical incomitance of >2Δ and persistent diplopia at 1 year after adjusting for the surgery variable (OR=1.07; p<0.04).

Conclusion

The present study has demonstrated that in orbital fracture patients, vertical incomitance was associated with (1) persistence of long-term diplopia, (2) the decision to perform surgery, and (3) the severity of the fracture.

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