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Impact of surgical timing of postoperative ocular motility in orbital blowout fractures
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  • Published on:
    Re: e Letter for bjophthalmol-2017-310312; Comments on article “Impact of Surgical Timing of Postoperative Ocular Motility in Orbital Blowout Fractures”

    Dr. Jost Jonas

    British Journal of Ophthalmology


    Dear Dr. Jonas:


    With great interest, we read the e letter (E-Letter 1) submitted by Ankita Anil Patil, Srikanth Ramsubramanian, and Bipasha Mukherjee, entitled “Comments on article ‘Impact of surgical timing on postoperative ocular motility in orbital blowout fractures’” illustrating their analysis and opinions on our article that was recently published in the British Journal of Ophthalmology. Please know that we greatly appreciate the authors’ cogent and helpful comments.


    It should be noted that in our opinion, in order to normalize ocular motility, the most important aspect is to restore the orbital tissues for the appropriate location. It is quite well known that the transcaruncular approach is suitable for small fractures of the medial wall. Since the transcaruncular approach provides surgeons with only a narrow view, it is difficult to restore the orbital tissues for the appropriate location for a large depressed fracture. On the other hand, the Lynch incision provides a substantial advantage for the repair of an orbital fracture, as it allows for a wide view during surgery and makes it easy to restore the orbital tissues for the orbit and insert the reconstruction implant. In additi...

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    Conflict of Interest:
    None declared.
  • Published on:
    Comments on article "Impact of surgical timing on postoperative ocular motility in orbital blowout fractures
    • Ankita Anil Patil, Paediatric ophthalmology fellow Sankara Nethralaya eye hospital,Chennai
    • Other Contributors:
      • Srikanth Ramasubramanian, Paediatric ophthalmologist
      • Bipasha Mukherjee, oculoplasty surgeon

    We have read the article”Impact of surgical timing of postoperative ocular motility in orbital blowout fractures” by Yukito Yamanaka, Akihide Watanabe, Chie Sotozono, Shigeru Kinoshita published in BJO on July 25 2017.The article discusses a new technique of Hess Area Ratio (HAR) and CT-scan findings for determining the appropriate time for surgery and predict the outcomes following orbital fracture repair.
    We want to congratulate the authors for this successful review article. We would like to comment on some points in the methodology and results of this article and make some contributions.The incisions described in the article have some shortcomings and are not currently the favoured approach. The Lynch incision described in the article has been the traditional approach for medial wall fractures but can result in severe scarring or webbing of the medial canthal skin ; therefore the transcaruncular approach is favoured.1 The subciliary incision too can cause ectropion and a transconjunctival approach is preferred.2 The number of patients mentioned in the results section who had poor improvement of HAR% differs being recorded as 22 earlier and then later in the article as 24.The diagnosis of tissue incarceration causing ocular motility disturbances after surgery is more related to various ocular motility tests rather than CT-SCAN findings alone.3 The authors have diagnosed muscle and tissue incarceration based solely on CT-SCAN findings and have not commented on t...

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    Conflict of Interest:
    None declared.