The aim of this study was to explore the effect of helmet eye movement training system in eye position and stereo vision rehabilitation of postoperative patients with orbital fracture.

A total of 40 patients (40 eyes) who underwent orbital fracture repair surgery in the Beijing Tongren Eye Center of Beijing Tongren Hospital affiliated to Capital Medical University from April to December 2018 were collected. There were 25 males (25 eyes) and 15 females (15 eyes). The age ranged from 7 to 55 years-old, with an average of (26.4±2.8) years-old. After operation, the helmet display equipment combined with the relevant visual perception biological model was used for eye movement, binocular integration and fixation stability rehabilitation training. The eye position, strabismus and static/dynamic stereoscopic vision were recorded after operation for 1 week, 1 month and 3 months. The mixed effect model was used to compare the changes of strabismus degree at different time points, and the generalized linear mixed effect model was used to compare the eye position deviation slope and static/dynamic stereo vision changes at different time points.

Among of 40 cases (40 eyes), there were 12 cases (12 eyes) of inferior orbital wall fracture, 6 cases (6 eyes) of medial orbital wall fracture, 19 cases (19 eyes) of medial inferior orbital wall fracture, 1 case (1 eye) of external inferior orbital wall fracture and 2 cases (2 eyes) of multiple fracture. One week after operation, there were 22 patients (22 eyes) with ocular deviation, accounting for 57.89%. One month after operation, there were 12 cases (12 eyes) with ocular deviation, accounting for 35.29%. Three months after operation, there were 3 cases (3 eyes) of eye position deviation, accounting for 9.68%. Compared with the generalized linear mixed effect model at each time point after operation, the horizontal deviation, vertical deviation and horizontal combined vertical deviation decreased gradually with time with the statistically significant difference between them (χ²=6.20, 6.21, 3.24; P<0.05). Further pairwise comparison of horizontal deviation group showed that there was significant difference between 1 week and 3 months after operation, 1 month and 3 months after operation (χ²=3.52, 2.06; P<0.05). Further pairwise comparison of vertical deviation group showed that there were significant differences between 1 week, 1 month and 3 months after operation (χ²=2.32, 3.42; P<0.05) . Further pairwise comparison of horizontal with vertical deviation group showed that there was significant difference between 1 week and 3 months after operation (χ²=2.49, P<0.05) . The degree of horizontal strabismus after operation for 1 week, 1 month and 3 months was (1.92±2.73)△, (1.29±2.24)△, (0.23±0.72)△, respectively. The degree of vertical strabismus after operation for 1 week, 1 month and 3 months was (2.61±4.22)△ , (0.74±1.76)△, (0.10±0.40)△, respectively. Compared with the mixed effect model, the degree of horizontal/vertical strabismus decreased gradually with time with the statistically significant difference between them (F=5.41, 7.83; P<0.05). There were significant differences in the degree of horizontal/vertical strabismus among 1 week, 1 month and 3 months after operation (t=-3, 28, 2.01, 2.86, 3.74; P<0.05). One week after operation, there were 22 patients (22 eyes) with positive static stereoscopic vision, accounting for 56.41%. One month after operation, there were 30 patients (30 eyes) with positive static stereoscopic vision, accounting for 81.08%. Three months after operation, there were 34 patients (34 eyes) with positive static stereoscopic vision, accounting for 91.89%.Compared with the generalized linear mixed effect model, the positive rate of static stereo vision gradually increased with time, and the difference was statistically significant (F=7.71, P<0.05). There were significant differences between 1 week and 1 month and 3 months after operation (t=-2.66, 3.82; P<0.05). One week after operation, dynamic stereoscopic vision passed through 29 patients (29 eyes), accounting for 74.36%. One month after operation, dynamic stereoscopic vision passed through 34 patients (34 eyes), accounting for 91.89%. Three months after operation, dynamic stereoscopic vision passed through 36 patients (36 eyes), accounting for 97.30%. Compared with the generalized linear mixed effect model, the passing rate of dynamic stereo vision gradually increased with time with the statistically significant difference between them (F=5.42, P<0.05). There were significant differences among 1 week, 1 month and 3 months after operation (t=-2.40, -3.14; P<0.05).

The application of helmet eye movement training system for rehabilitation training in postoperative patients with orbital fracture can reduce the degree of eye position deviation, help to restore stereoscopic vision and improve the quality of binocular vision.