Hess Area Ratio and Diplopia: Evaluation of 30 Patients Undergoing Surgical Repair for Orbital Blow-Out Fracture

Grenga, Pier Luigi; Reale, G; Cofone, Carmela; Meduri, Alessandro; Ceruti, Piero; Grenga, Roberto

doi:10.1097/iop.0b013e31819a41d5

Cited by 14 publications

(10 citation statements)

References 7 publications

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“…We used HAR% as an objective parameter to evaluate ocular motility. It had proven effective in predicting diplopia in orbital blowout fractures by Pier et al 10 Our patients reported no diplopia with HAR% > 83.3%, and this was similar to that reported in other studies with HAR% > 85% 15 . Our postoperative HAR% showed a huge improvement from 55.1% ± 22.0% to 93.7% ± 12.2%, which was close to the final follow-up HAR% (92.9% ± 10.5%) examined by Yamanaka et al 16 We proved that it is an easy and reliable measurement of orbital trapdoor fracture patients after comparing it with patients' subjective complaints and the results of previous studies.…”

Section: Discussionsupporting

confidence: 91%

“…To evaluate ocular motility disturbance, manual Hess screen testing and extraocular muscle movement (EOM) were performed at presentation and at 3-month follow-up after surgical treatment. We used Hess Area Ratio (HAR%), the percentage of square area of the affected side compared with the healthy side on the Hess chart, which was proven effective in predicting postoperative diplopia by Pier et al 10 , to compare the improvement in ocular motility after surgical reduction. On orbital CT, the orbital fracture site was classified as per the classification in the study conducted by Takahashi et al 3 : horizontally divided into lateral (A1) or medial (A2) to the infraorbital groove/canal, the inferomedial orbital strut (A3), and the medial orbital wall (A4); longitudinally divided into anterior third (S1), middle third (S2), and posterior third (S3).…”

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confidence: 99%

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Factors influencing surgical outcomes in orbital trapdoor fracture

Chen

Tsai

Tzeng

2021

Sci Rep

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This study is aimed to determine the appropriate timing of performing surgical reduction on trapdoor fractures for bringing out better visual outcomes and the factors influencing surgical outcomes in this special subgroup of fracture victims. Data for 72 patients of orbital trapdoor fracture were analyzed retrospectively. Post-operative diplopia is the main posttreatment outcome of orbital bone fracture reduction. The receiver-operating characteristic (ROC) analysis indicated the cut-off point of surgical reduction timing at day 10 post-fracture. The rate of postoperative diplopia showed a significant difference between patients who underwent surgical reduction within 10 days and those who did after 10 days of injury (5.3% vs. 38.2%). Multivariate analysis revealed that preoperative infra-duction limitation (p = 0.02), muscle incarceration (p = 0.01), duration from injury to surgical reduction (p = 0.004), and postoperative supra-duction limitation (p = 0.004) were independent factors for poor surgical outcomes. In younger patients with head injury, the diagnosis of orbital trapdoor fracture should be kept in mind. Timely recognition and surgical reduction, especially within 10 days, can result in better visual outcomes without the occurrence of postoperative diplopia.

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Section: Discussionsupporting

confidence: 91%

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confidence: 99%

Factors influencing surgical outcomes in orbital trapdoor fracture

Chen

Tsai

Tzeng

2021

Sci Rep

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“… 3 Pier et al reported that HAR% was effective for predicting postoperative diplopia in 30 patients undergoing surgical repair for orbital blowout fractures. 4 In those reports, all patients with preoperative HAR >85% had no postoperative diplopia. In our present study, the mean final follow-up HAR% (92.9%±10.5%) was significantly better than that of the initial HAR% (73.5%±21.7%) (p<0.01).…”

Section: Discussionmentioning

confidence: 90%

“… 3 In addition, Pier et al reported that HAR% was effective in predicting postoperative diplopia in 30 patients undergoing surgical repair for orbital blowout fractures. 4 The aim of this present study was to elucidate the best timing for surgical repair of orbital blowout fractures by use of HAR% for objective evaluation of ocular motility.…”

Section: Introductionmentioning

confidence: 99%

Impact of surgical timing of postoperative ocular motility in orbital blowout fractures

et al. 2017

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PurposeTo investigate the surgical timing postinjury in regard to ocular motility in patients with orbital-floor blowout fractures.MethodsThis study involved 197 eyes (92 right eyes and 105 left eyes) of 197 patients (154 males and 43 females, mean age: 29.0 years, range: 7–85 years) with pure orbital blowout fractures. All patients underwent surgical repair within 30 days postinjury and were followed up for 3 months or more postoperative (mean follow-up period: 8.4 months, range: 3–59 months). Orbital blowout fractures were classified into one of three shapes: (1) trap-door fracture with muscle entrapment, (2) trap-door fracture with incarcerated tissue and (3) depressed fragment fracture. Ocular motility was estimated by percentage of Hess area ratio (HAR%) on the Hess chart at the final follow-up examination. In addition, correlations between postinjury surgical timing and HAR% were analysed.ResultsThe mean postinjury surgical timing was 10.7±7.8 days (range: 0–30 days). The mean postoperative HAR% (92.9%±10.5%) was significantly improved compared with preoperative HAR% (73.5%±21.7%) (p<0.01). The mean postoperative HAR% (98.3%±4.4%) of the orbital-floor trap-door fracture patients with incarcerated tissue who underwent surgical repair within 8 days postinjury was significantly better than that of the patients who underwent surgical repair after 8 days (94.2%±5.8%) (p<0.01).ConclusionsPatients with orbital-floor trap-door blowout fractures with incarcerated tissue that were repaired within 8 days postinjury had better outcomes than those repaired after 8 days, and HAR% is a useful method to record orbital fracture surgical outcomes.

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“…However, single method cannot fulfill the requirement of clinical practice as the variability of diplopia. To quantify diplopia, there are some methods such as Hess weighted score [1] and Hess area ratio [2] . They both were limited in clinical application and research because of their complexity [3][4] .…”

Section: Introductionmentioning

confidence: 99%

A new interpretation and quantitative method for diplopia test: 304 cases of ocular motor nerve palsy for clinical test and verify

2017

Int J Ophthalmol

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We introduce a new interpretation and quantitative method for computerized diplopia test. By comparing this new method to the Hess screen test, we validate its applicability among 304 patients with ocular motor nerve palsy. This new method shows great assistant value as the Hess screen test in making accurate diagnosis and quantitative evaluation the severity of diplopia. Furthermore, it is more convenient and suitable for daily clinical use.

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Hess Area Ratio and Diplopia: Evaluation of 30 Patients Undergoing Surgical Repair for Orbital Blow-Out Fracture

Abstract: The Hess area ratio is a useful procedure to convert Hess graphic representation in a numerical value so that Hess chart data can be compared among clinicians and used to predict surgical outcomes in patients undergoing surgery for orbital blow-out fractures.

Cited by 14 publications

References 7 publications

Factors influencing surgical outcomes in orbital trapdoor fracture

Factors influencing surgical outcomes in orbital trapdoor fracture

Impact of surgical timing of postoperative ocular motility in orbital blowout fractures

A new interpretation and quantitative method for diplopia test: 304 cases of ocular motor nerve palsy for clinical test and verify

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