Page 137 - Advanced concepts in orbital wall fractures
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                                General discussion and future perspectives
important to determine whether they are cost-effective and what health gains can be achieved based on clinical outcomes.
An ongoing challenge for the future is further improvement of the clinical protocols for orbital wall fractures. There is still a blurred area for indications and timing for orbital reconstruction. Predictive values of chronic sequelae can play a key role in solving these issues19,28. More detailed analysis and understanding of the soft tissues and its response to trauma and surgery is required to determine in which cases late enophthalmos or persistent diplopia will occur. This could be realised with finite-element analysis models of orbital biomechanics. Perhaps high- resolution 7-Tesla magnetic resonance imaging can help with a detailed examination of the damaged suspension system, and the occurrence of posttraumatic fat atrophy, adhesions, and fibrosis. Based on the findings, clinical protocols can be further investigated in larger cohorts or, preferably, randomised controlled clinical trials. The management of orbital wall fractures may further be improved with the use of collective (big) data. An automated accurate prediction may become possible for various issues. For instance, to investigate the appropriate techniques for each specific fracture during orbital reconstruction, which cases should be referred to a specialised centre, or what the exact indications are for surgery.
Besides detailed objective orthoptic measurements, future orbital C research should be substantiated by subjective patient-reported 7 outcome measures (PROM), such as mood and feelings or quality-of-life questionnaires. These PROMs are so far rarely used as a primary outcome
measure in orbital fractures, although they are expected to offer a clear insight into the aesthetic and functional impact of the sequelae and complications.
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