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  • AAO OTAC Oculoplastics and Orbit Panel, Hoskins Center for Quality Eye Care


    A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Oculoplastics and Orbit Panel

    Timothy J. McCulley, MD,1 Vinay K. Aakalu, MD, MPH,2 Jill A. Foster, MD,3, 4 Suzanne K. Freitag, MD,5 Lora R. Dagi Glass, MD,6 Seanna R. Grob, MD,7 Jeremiah P. Tao, MD,8 M. Reza Vagefi, MD,9 Michael T. Yen, MD,10 Michael K. Yoon, MD,11, 12 Stephen J. Kim, MD,13 Edward Wladis, MD14

    Ophthalmology, In Press, © 2024 by the American Academy of Ophthalmology. Click here for free access to the OTA.

    Purpose: To review the efficacy and safety of the use of intraoperative image guidance (IIG) in orbital and lacrimal surgery.

    Methods: A literature search the PubMed database was last conducted in November 2023 for English-language original research that assessed the use of any image guidance system in orbital and lacrimal surgery that included at least 5 patients. The search identified 524 articles; 94 were selected for full-text analysis by the panel. A total of 32 studies met inclusion criteria. The panel methodologist assigned a level II rating to 2 studies and a level III rating to 30 studies. No study met the criteria for level I evidence.

    Results: Procedures reported on were as follows: fracture repair (n=14), neoplasm and infiltrate biopsy or excision (n=6), orbital decompression for Graves ophthalmopathy (n=3), dacryocystorhinostomy (n=1), and mixed etiology and procedures (n=8). Four studies used more than one IIG system. One study that met level II evidence criteria compared the outcomes of orbital fracture repair with IIG (n=29) and without IIG (n=29). Borderline better outcomes were reported in the IIG group: 2% versus 10% with diplopia (P = 0.039) and 3% versus 10% with enophthalmos (P = 0.065). The other level II study compared the repair of fractures with navigation (n=20) and without (n=20). The group in which navigation was used had a measured mean volume reduction of 3.82 cm3 compared with 3.33 cm3 (P = 0.02), and there was a greater measured reduction in enophthalmos in the navigation group of 0.72mm (P = 0.001). Although the remaining 30 assessed articles failed to meet level II criteria, all alleged a benefit from IIG. No complications were reported.

    Conclusions: A small number of comparative studies suggest that there are improved outcomes when IIG is used in orbital fracture repair, but each study suffers from various limitations. No high-quality comparative studies exist for the management of lacrimal surgery, neoplastic disease or decompression. Complications attributable to the use of IIG have not been identified and IIG has not been analyzed for cost savings.

    1Department of Ophthalmology, John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas
    2Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor Michigan
    3Ophthalmic Surgeons and Consultants of Ohio, Columbus, Ohio
    4The Ohio State University, Ohio University Heritage College of Osteopathic Medicine, Athens, Ohio
    5Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
    6Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, New York, New York
    7Department of Ophthalmology, University of California San Francisco, San Francisco, California
    8Gavin Herbert Eye Institute, University of California, Irvine School of Medicine, Irvine, California
    9Tufts University School of Medicine, Boston, Massachusetts
    10Cullen Eye Institute, Baylor College of Medicine, Houston, Texas
    11Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
    12Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts
    13Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
    14Ophthalmic Plastic Surgery, Lions Eye Institute, Department of Ophthalmology, Albany Medical Center, Albany (Slingerlands), New York