A Risk Calculator for Predicting Enophthalmos following Orbital Fracture Repair

Area of Science:

• Ophthalmology
• Trauma Surgery
• Medical Informatics

Background:

• Enophthalmos is a common complication following orbital fracture repair (OFR).
• Predictive factors for postoperative enophthalmos after OFR are not well-established.
• Accurate prediction of enophthalmos is crucial for managing patient expectations and surgical planning.

Purpose of the Study:

• To develop and validate a predictive risk calculator for postoperative enophthalmos after OFR.
• To identify key risk factors associated with the development of enophthalmos post-orbital fracture repair.
• To improve the accuracy of enophthalmos prediction in patients undergoing OFR.

Main Methods:

• Retrospective review of adult trauma patients undergoing OFR at two centers over 8 years.
• Exclusion of patients with less than 2 weeks of postoperative follow-up.
• Development and validation of a risk model using C-statistic and Hosmer-Lemeshow tests.

Main Results:

• The study included 349 patients, with 7.7% experiencing postoperative enophthalmos.
• Identified risk factors: older age, preoperative enophthalmos, medial wall involvement, extensive orbital floor defects, and delayed repair (>1 month).
• The risk model demonstrated high accuracy (C-statistic=84.5% development, 89% validation) and excellent negative predictive value (99%).

Conclusions:

• The first validated risk calculator for predicting enophthalmos after OFR has been developed.
• This tool allows surgeons to effectively rule out postoperative enophthalmos preoperatively in most patients.
• The risk calculator aids in surgical decision-making and patient counseling for orbital fracture repair.