Adhesiotomy with grafting of fat and perifascial areolar tissue for adhesions of extraocular muscles after trauma or surgery.

PURPOSE: To investigate the effect of adhesiotomy with grafting of fat and perifascial areolar tissue (A-GFPAT) on eyes with restricted eye movements after trauma or surgery.

DESIGN: Single-center retrospective interventional, consecutive case series.

METHODS: Twenty-four eyes of 24 patients that underwent A-GFPAT were studied. The changes in the eye movements was evaluated by the Hess area ratio (HAR %) and in the binocular single vision (BSV) field scores.

RESULTS: The HAR % was significantly improved by the A-GFPAT, from 50.9 ± 32.0% (±SD) to 66.4 ± 28.2% at the final visit (Student's t test; P < 0.01). Nine of the 24 cases (37.5%) had an improvement of the final HAR % by >10%. The preoperative mean BSV field score was 15.4 ± 13.3, which improved significantly to 25.9 ± 10.5 after the A-GFPAT (P < 0.001). Thirteen cases (56.5%) had an improvement of the final BSV score by more than 5 points. There were improvements of both HAR % (50%) and BSV score (54.5%) by more than 50% after A-GFPAT in patients with old orbital fractures. All patients who had been treated with Lactosorb earlier had an improvement of the BSV score, while those treated with endoscopic transmaxillary reduction and balloon technique had a lower chance of improvement (20%).

CONCLUSIONS: Our new technique of A-GFPAT leads to improvements of eye movements that had been limited by the adhesion of orbital soft tissue and periorbita with less adverse effects. We recommend our surgical procedure for eyes with restrictive eye movements or pain caused by adhesions following trauma or ocular surgery.