Epidemiological analysis of patients with isolated blowout fractures of orbital floor: Correlation between demographic characteristics and fracture area.

Isolated orbital floor fractures are more frequent due to low bone thickness (2 mm). The aim of this study was to conduct a retrospective epidemiological analysis on these fractures, investigating demographic variables and fractures' features and their statistical correlation. A total of 120 patients with isolated orbital floor fracture, admitted at the Maxillofacial Surgery Unit of University of Naples Federico II, from 2010 to 2022 were enrolled in the study. Patients were evaluated for age, sex, smoke, comorbidities, post-traumatic clinical manifestation,s and defect side and size. Statistical analysis was conducted using the Pearson regression coefficient (r). The fractures were more frequent in men (male:female 2.2:1) because of road accidents (30% of cases). The average age was 48 years. Enophthalmos, diplopia and ocular motility anomalies were observed in 31%, 23% and 21% of cases, respectively. Statistical analysis revealed that age was related to fracture area; in particular, older patients showed larger fractures (p < 0.001). Interpersonal violence and traffic accidents were related to younger age (p < 0.001). Data analysis revealed that isolated orbital floor fractures are more frequent in young men (<40 years) because of road accidents or interpersonal violence. There is a statistical correlation between fracture area and patient age; in particular, older age corresponds to larger defects.

Descemetic DALK and predescemetic DALK: outcomes in 236 cases of keratoconus.

PURPOSE: To report the outcomes of our experience with deep anterior lamellar keratoplasty (DALK) in patients with keratoconus. METHODS: A retrospective evaluation of 236 eyes of 198 patients that have undergone DALK between 2000 and 2006 using the Tsubota, Sugita, Melles, or Anwar technique. We analyzed the frequency of true Descemet membrane exposure, which we termed dDALK, and the number of eyes in which a predescemetic plane was achieved, which we termed pdDALK. Pre- and postoperative visual acuity, endothelial cell count, and central corneal thickness were evaluated on 120 eyes followed in our department. RESULTS: A total of 139 of 236 (59%) eyes were classified as dDALK, with the Anwar technique showing the highest incidence of exposure of Descemet's membrane (127 of 164, 77%). Descemet ruptures occurred in 25 of 236 cases (10.5%). Three ruptures were converted to penetrating keratoplasty (PK). There was no difference in visual acuity between the pdDALK and dDALK groups at an average follow-up of 30.4 months, although the eyes in the dDALK group seemed to have faster visual recovery. Best spectacle corrected visual acuity postoperatively was at least 20/30 in 80-85% of eyes at the patient's last visit. Endothelial cell loss was 11-13%, with most of the loss occurring in the first 6 months. CONCLUSIONS: Performing DALK, we had the greatest likelihood of reaching Descemet's membrane with the Anwar Big Bubble technique. The visual outcomes are comparable to standard PK, avoiding the risk of endothelial rejection. Endothelial cell loss was low and the cell count was stable after 6 months.