Secondary reconstruction of residual enophthalmos using an endoscope and considering the orbital floor and medial wall slope

Purpose: To present a transconjunctival and transcaruncular endoscopy approach involving layered porous polyethylene barrier implants to manage residual posttraumatic enophthalmos and to evaluate the effectiveness of this technique. Methods: The authors performed a retrospective review of all patients who underwent secondary reconstruction of orbital wall fractures because of residual enophthalmos between June 2008 and July 2015. Patients' demographics, degree of enophthalmos, ocular motility, diplopia test results, and surgical complications were reviewed. Results: This study included 16 eyes (4 right eyes and 12 left eyes) of 16 patients (14 males and 2 females). The mean time interval from trauma to surgery was 7.1 months (range, 1-18 months). The average postoperative follow-up period was 6.4 months (range, 3-18 months). The degree of enophthalmos preoperatively and at 1 week, 1 month, and 3 months postoperatively was 2.47 mm (range, 2 to 3 mm), 0.5 mm (range, 0.5 to 2.5 mm), 0.06 mm (range, 0.5 to 1.5 mm), and 0.44 mm (range, 1.5 to 1.0 mm), respectively. There were no definite surgical complications in any patients. Conclusion: Dissection to the posterior margin of the fracture and reconstruction of the orbital floor slope are the most important surgical factors to prevent residual enophthalmos and scarring with recurrent diplopia. Demonstration of slight exophthalmos of the corrected side of about 1 to 2 mm at the end of the operation is also necessary. The authors believe that surgery using an endoscope and layered porous polyethylene is very useful for secondary reconstruction.