{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:15:02Z","timestamp":1790036102768,"version":"4.0.1"},"reference-count":33,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,4,22]]},"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/Aims<\/jats:title>\n                    <jats:p>To ascertain factors associated with persistent diplopia after orbital fracture reconstruction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, we reviewed 798 cases with depressed fragment fracture at the Department of Kyoto Prefectural University of Medicine Hospital between January 2009 and November 2023. The restriction of extraocular movements and diplopia was assessed using the Hess area ratio (HAR). The factors for HAR% \u226585% before surgery and 6 months after surgery were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 798 cases in this study, 437 cases (54.8%) had an HAR% of \u226585%,\u2009and 361 cases (45.2%) had an HAR% of &lt;85% before surgery. Age \u226418 years old (p=0.017), orbital tissue herniation volume &lt;median (p=0.001), absence of extra-ocular muscle deviation (p&lt;0.001) and medial wall (vs medial wall and orbital floor with strut fracture; p&lt;0.001) were found to be associated with HAR% \u226585% before surgery. Of the 332 cases treated with surgery, 272 cases (81.9%) were HAR% \u226585%,\u2009and 60 cases (18.1%) were HAR%&lt;85% after surgery. Age \u226418 years old (p=0.011), male (p=0.014), absence of extra-ocular muscle deviation (p=0.002) and medial wall (vs medial wall and orbital floor with strut fracture; p=0.002) were found to be associated with HAR% \u226585% at 6 months post surgery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients of younger age, male and those with absence of extraocular muscle deviation have better eye movements in the affected eye (increased HAR%) 6\u2009months after surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-327299","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T13:20:19Z","timestamp":1746192019000},"page":"1202-1206","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Factors associated with diplopia before and after orbital blowout 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