Background Orbital blow-out fracture often results in the abnormalities of appearance and function of eye.Because of the special and complex anatomical structure of orbital cavity,it is difficult to design and manufacture the corresponding orbital implants.The computer-aided designing and manufacturing (CADM) technology provides a new approach to orbital implants.However,the clinical value of this method is still under evaluation.Objective This study was to investigate the application and the therapeutic effect of CADM for orbital blow-out fracture.Methods The clinical data of 74 eyes of 74 patients who received surgery for orbital blow-out fracture from July 2006 to July 2012 in Henan Eye Institute,Henan Eye Hospital were retrospectively analyzed.Fiftyeight patients underwent CADM implanted surgery and 16 patients received non-CADM surgery in the same period with matched age,gender and lateral eyes in both groups.The individualized 3D orbital implants were designed and manufactured by the technology of CADM and then were implanted in the bone defects in the CADM group,while the traditional hydroxyapatite artificial bone or high density porous polyethylene material (Medpor) was utilized in the non-CADM group with a fellow-up duration for 22 to 69 months.The best corrected visual acuity (BCVA),eyeball exophthalmos,ocular position,eye movement,diplopia and postoperative complications were evaluated.Results The preoperative BCVA were 0.71±0.37 and 0.69±0.41,and the postoperative BCVA were 0.74±0.38 and 0.72±0.41 in the CADM group and the non-CADM group,respectively,showing an insignificant intergroup difference (Fgroup =0.043,P=0.837),but a significant variation was found over time (Ftime =13.576,P ＜ 0.01).The BCVA was significantly improved after surgery compared with before surgery in both groups (both at P＜0.05).No significantdifferences were found in the number of eyes with curative and improved diplopia and eye movement disorders between the two groups during the fellow-up duration (Z =-0.298,P =0.766;Z =-0.548,P =0.584).The preoperative eyeball exophthalmos values were (3.93±0.99)mm and (3.88±0.97)mm and the postoperative ones were (0.91 ±0.67)mmand (1.84±0.80) mm in the CADM group and the non-CADM group,respectively,without significant differencebetween the two groups (Fgroup =3.558,P =0.063).However,the eyeball exophthalmos values after operation wereremarkably lower than those before operation in both groups (both at P＜0.05).CT imaging displayed implants fitting well with fracture defect and attached to bone tissue accurately in all of the eyes in the CADM group,but in the nonCADM group,the bulge of implants damaging extraocular muscles or optical nerve was found in 2 eyes.No postoperative complication was seen throughout the fellow-up duration in the CADM group.Conclusions CADM technology for orbital blow-out fracture can reconstruct a 3D bony orbit and effectively repair ocular position and appearance,and furthermore restore eye movement and visual functions.The therapeutic outcome of CADM technology for orbital blow-out fracture is superior to conventional implants.

Objective:To investigate influencing factors of persistent diplopia after orbital floor blowout fracture reconstruction surgery.Methods:A case control study was conducted.Data of 146 eyes of 146 orbital floor blowout fracture patients with diplopia occurring 1 day after operation were collected in Henan Eye Hospital from July 2011 to July 2020.The patients were divided into two groups, persistent diplopia group (14 cases 14 eyes) and disappeared diplopia group (132 cases 132 eyes), according to the persistence of diplopia in the follow-up.Differences in sex, right or left eye, age, preoperative course of disease, preoperative intraorbital soft tissue hernia, operation methods, operation approach, postoperative eyeball rotation exercise compliance, the number of eyes with postoperative inferior rectus muscle damage level were compared between the two groups to select factors with P<0.05 for multifactor logistic regression analysis.This study protocol adhered to the Declaration of Helsinki and was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2021[15]). Results:All eyes were successfully operated and no complications such as infection or dislocation of the orbital implant occurred in any of the eyes during the postoperative follow-up period.There were statistically significant differences in age, preoperative course of disease, preoperative intraorbital soft tissue hernia, operation methods, postoperative eyeball rotation exercise compliance and postoperative inferior rectus muscle injury between the two groups ( χ 2=9.443, P=0.002; χ 2=29.041, P<0.001; H=53.943, P<0.001; H=34.583, P<0.001; χ 2=46.041, P<0.001; H=101.438, P<0.001). The multiple logistic regression analysis indicated that the long preoperative course of disease ( OR=8.678, 95% CI=1.013-74.304, P=0.031), preoperative intraorbital soft tissue hernia (Severe: OR=32.963, 95% CI=7.647-142.084, P<0.001.Moderate: OR=11.852, 95% CI=2.679-52.436, P=0.001), and postoperative inferior rectus muscle injury (Severe: OR=511.000, 95% CI=42.815-6 110.808, P<0.001.Moderate: OR=132.000, 95% CI=12.442-1 400.458, P<0.001) were independent risk factors for postoperative persistent diplopia.Advanced operation methods (Individualized shaped titanium mesh method: OR=0.020, 95% CI=0.002-0.127, P<0.001.Manufacturers prefabricated titanium mesh method: OR=0.031, 95% CI=0.004-0.257, P=0.001), and the postoperative eyeball rotation exercise ( OR=0.015, 95% CI=0.001-0.197, P<0.001) were independent protective factors for postoperative persistent diplopia. Conclusions:Severe preoperative intraorbital soft tissue hernia and postoperative inferior rectus muscle injury are the main risk factors for persistent postoperative diplopia after orbital floor blowout fracture repair surgery.Shortening the preoperative course of disease, improving the operation methods, and enhancing postoperative ocular functional exercises may reduce the incidence of postoperative persistent diplopia.

Objective:To analyze the related risk factors for vertebral artery tortuosity, and explore the mechanism of vertebral artery tortuosity.Methods:Two hundred and eighty-two patients accepted head/neck and MR angiography in our hospital from October 2016 to October 2017 were selected. The tortuosity degrees of vertebral artery were measured and calculated by PACS system. The differences of tortuosity degrees of vertebral arteries in different age groups were compared. Correlation analysis was performed to determine the correlation between vertebral artery tortuosity and both clinical data and and biochemical levels, and multivariate linear regression analysis was performed to determine the independent risk factors for vertebral artery tortuosity.Results:The tortuosity degrees of the left and right vertebral arteries in these patients ranged from 5.1% to 72.6%. The tortuosity degrees of vertebral arteries in patients aged 40-49 years were significantly higher than those in patients aged 20-29 years and 30-39 years ( P<0.05). Correlation analysis showed that the tortuosity degree of the right vertebral artery was positively correlated with age and triglyceride level ( r=0.232, P=0.000; r=0.172, P=0.004); the tortuosity degree of the left vertebral artery was positively correlated with triglyceride level ( r=0.123, P=0.043). Multivariate regression analysis showed that age ( 95%CI: 0.059-0.194, P=0.000) and triglyceride level ( 95%CI: 0.173-1.942, P=0.019) were independent risk factors for right vertebral artery tortuosity. Triglyceride level ( 95%CI: 0.041-2.559, P=0.043) was independent risk factor for left vertebral artery tortuosity. Conclusion:There are congenital developmental factors associated with vertebral artery tortuosity; some nurture factor, as triglyceride level, may promote its development.

Objective:To investigate the protective effect of a modified orbital decompression on postoperative eye position in thyroid-associated ophthalmopathy (TAO).Methods:A cohort study was performed.One hundred and thirty-six eyes of 96 TAO patients who received orbital decompression in Henan Eye Hospital from July 2008 to July 2018 were enrolled.The patients were divided into two groups according to different operation methods.A depressed bone window was made in the region of orbital apex in the modified orbital decompression group with 100 eyes of 70 patients.A depressed bone window was made in the middle and anterior region of orbit in the traditional orbital decompression group with 36 eyes of 26 patients.The best corrected visual acuity, palpebral fissure, eyeball exophthalmos, strabismus, eyeball position、CT image and postoperative complications were compared.This study was approved by the Ethics Committee of Henan Eye Hospital (No.HNEECKY-2020[07]), and written informed consent was obtained from each subject before surgery.Results:Strabismus was improved in 14 eyes of 10 patients, unchanged in 75 eyes of 52 patients and slightly aggravated in 11 eyes of 8 patients after operation in the modified orbital decompression group.In the traditional orbital decompression group, strabismus was slightly aggravated in 6 eyes of 4 patients, seriously aggravated in 30 eyes of 22 patients after surgery. In the modified orbital decompression group, the eyeball displacement was unchanged in 91 eyes of 64 patients, slightly aggravated in 9 eyes of 6 patients after surgery in the traditional orbital decompression group, the eyeball displacement was slightly aggravated in 15 eyes of 10 patients, seriously aggravated in 21 eyes of 16 patients after surgery.Significant differences were found in the number of eyes with different degree of strabismus and eyeball displacement between the two groups ( Z=-9.634, -10.278, both at P<0.01). The postoperative eyeball exophthalmos values were (14.36±2.03)mm and (14.36±1.03)mm in the modified orbital decompression group and the traditional orbital decompression group, respectively, which were significantly lower than preoperative (20.47±1.92)mm and (20.28±2.03)mm (both at P<0.05). CT imaging showed that the bone window was clear in orbital apex and the compression of optic nerve was relieved postoperatively in the modified orbital decompression group, and the bone window was in anterior part of the orbit and the orbital apex was still crowded in the traditional orbital decompression group.No severe complication was seen during the fellow-up duration in the two groups. Conclusions:Compared with traditional orbital decompression, the modified orbital decompression surgery can reduce the risks of strabismus and eyeball displacement, showing an obvious protective effect on eye position.