The following is a summary of “Intraoperative image guidance in orbital and lacrimal surgery,” published in the June 2024 issue of Ophthalmology by McCulley et al.

Researchers conducted a retrospective study to review the effectiveness and safety of intraoperative image guidance (IIG) during orbital and lacrimal surgeries. 

They searched the PubMed database in November 2023 for English studies with at least 5 patients who used image guidance systems in orbital and lacrimal surgery. Of 524 articles, 94 were reviewed, 32 met the criteria and 2 studies were rated level II, 30 were rated level III, and none reached level I. 

The results showed that the procedures included fracture repair (n=14), neoplasm and infiltrate biopsy/excision (n=6), orbital decompression for Graves (n=3), dacryocystorhinostomy (n=1), and mixed (n=8). About 4 studies used multiple IIG systems, a level II study found better outcomes with IIG for fracture repair (n=29) and without IIG (n=29): diplopia 2% vs. 10% (P=0.039), enophthalmos 3% vs. 10% (P=0.065). Another level II study compared fracture repair using navigation (n=20) and without navigation (n=20) reduced fracture volume by 3.82 cm³ vs. 3.33 cm³ (P=0.02) and enophthalmos by 0.72 mm (P=0.001). All 30 other studies reported benefits from IIG with no complications. 

Investigators concluded that IIG might improve outcomes in orbital fracture repairs, but the studies have limitations. There is no high-quality research on lacrimal surgery, neoplastic disease, or decompression. No IIG-related complications were found, and cost savings haven’t been analyzed.

Source: aaojournal.org/article/S0161-6420(24)00307-5/abstract#%20