Computer-Assisted Three-Dimensional Planning for Orbital Decompression

Abstract

Thyroid-associated orbitopathy is the most common cause of unilateral or bilateral proptosis in adults. A mainstay of surgical treatment is orbital decompression utilizing osteotomies to increase the size of the affected bony orbit to accommodate the larger soft tissue volume. Over the past several decades, numerous approaches have been described for orbital decompression. However, given the intricate osseous and soft tissue anatomy within the orbit, orbital decompression is a potentially hazardous intervention. With advances in three-dimensional imaging and virtual planning, extensive orbital decompressions can be performed safely and efficiently. In this report, we describe two cases of three-wall orbital decompressions using three-dimensional planning.

Influence of orbital morphology on proptosis reduction and ocular motility after decompression surgery in patients with Graves’ orbitopathy

“…One reason is probably the limitations of two-dimensional measurements: Curved orbital walls are measured with straight measurements [50]. Newer, more complex techniques in three-dimensional scans are able to map the real orbit and not only an approximation [28, 36, 37, 51]. However, even they might not be sufficient, since the prolapse of orbital tissue during decompression surgery shows great individual variety.…”

“…Recently, single-center experiences with different three-dimensional planning approaches have been described. However, there has been no data on the efficacy of these techniques yet [36, 37].…”

Establishment of magnetic resonance imaging 3D reconstruction technology of orbital soft tissue and its preliminary application in patients with thyroid‐associated ophthalmopathy

“…Notably, this technology is currently accessible to clinicians and researchers. Compared to MRI, CT is more widely used by surgeons due to its ability to precisely reconstruct data using better threshold separation . The advantage of MRI, however, lies in the avoidance of radiation exposure, which is greatly appreciated in oriental culture.…”

Practice Patterns in Orbital Decompression Surgery Among American Society of Ophthalmic Plastic and Reconstructive Surgery Members

“…Intraorbital hemorrhage can occur with orbital decompression and can lead to vision loss from orbital compartment syndrome. Some have suggested placing a drain in the orbit as a method of prevention, but in this study only 17.8% of surgeons reported that they routinely do so [14, 21]. Overnight admission for observation can be considered, and in our survey 44.4% of surgeons stated that they routinely admit patients following decompression surgery.…”

“…Stereotactic navigation has been described for orbital decompression surgery as a method allowing the precise removal of the maximum amount of bone during surgery while using a smaller incision, particularly when identifying the safe limits of bony lateral decompression [20, 21]. However, the use of this technology may be limited by the learning curve involved as well as the high cost of the equipment [20].…”