Department of Ophthalmology, University Hospitals Leuven, Leuven, Belgium; Department of Neurosciences, Faculty of Medicine, Catholic University Leuven, Leuven, Belgium.
Department of Ophthalmology, Baylor College of Medicine, Houston, TX, USA.; Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Surv Ophthalmol. 2023 Mar-Apr;68(2):265-279. doi: 10.1016/j.survophthal.2022.11.003. Epub 2022 Nov 11.
In the management of orbital disorders and defects, minimally invasive surgical approaches have become increasingly efficient for their reduction of operative trauma and access without compromise of therapeutic benefit or diagnostic yield. Various approaches have focused on bone- and canthal-sparing techniques and concealed and small skin incisions. We review the current state of knowledge of procedures to enter the orbit via the conjunctiva. Any quadrant of the orbit can be accessed via the conjunctiva. Surgical incisions involve the orbital palpebral, forniceal, and bulbar conjunctiva. According to the location, nature, and size of the lesion, the transconjunctival orbitotomy can be used as a single procedure, in combination with a caruncular approach or as an adjunct in a multidisciplinary procedure for lesions extending deep into or outside the orbit. The working space and field of operating view can be expanded by releasing the horizontal tension of the eyelid with a lateral cantholysis, lateral paracanthal blepharotomy, or medial lid split procedure. Complications related to the conjunctival incision are reduced to dry eye disease.
在眼眶疾病和缺损的治疗中，微创外科方法因其减少手术创伤和不影响治疗效果或诊断收益的优势而变得越来越有效。各种方法都集中在骨和内眦保留技术以及隐蔽和小的皮肤切口上。我们回顾了通过结膜进入眼眶的现有知识状态。任何象限的眼眶都可以通过结膜进入。手术切口涉及眼睑、穹窿和球结膜。根据病变的位置、性质和大小，经结膜眶切开术可单独作为一种手术方法，与泪阜入路联合使用，或作为病变延伸至眼眶深部或外部的多学科手术的辅助手段。通过外侧眦切开术、外侧眦旁切开术或内侧睑裂切开术释放眼睑的水平张力，可以扩大工作空间和手术视野。与结膜切口相关的并发症减少到干眼症。
