Department of Ophthalmology, John P. McGovern Medical School, University of Texas Health Science Center, Houston, Texas.
Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan.
Ophthalmology. 2024 Nov;131(11):1333-1338. doi: 10.1016/j.ophtha.2024.05.014. Epub 2024 Jun 24.
To review the efficacy and safety of the use of intraoperative image guidance (IIG) in orbital and lacrimal surgery.
A literature search of 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.
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 cm compared with 3.33 cm (P = 0.02), and there was a greater measured reduction in enophthalmos in the navigation group of 0.72 mm (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.
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.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.
回顾术中影像引导（IIG）在眼眶和泪道手术中的疗效和安全性。
对 2023 年 11 月发表的评估在眼眶和泪道手术中使用任何图像引导系统（至少包括 5 例患者）的英文原始研究进行了 PubMed 数据库文献检索。该检索确定了 524 篇文章；专家组对 94 篇文章进行了全文分析。共有 32 项研究符合纳入标准。专家组方法学家将 2 项研究评为 II 级，30 项研究评为 III 级。没有研究符合 I 级证据标准。
报告的手术程序如下：骨折修复（n=14）、肿瘤和浸润活检或切除（n=6）、格雷夫斯眼病的眼眶减压（n=3）、泪囊鼻腔吻合术（n=1）以及混合病因和手术（n=8）。四项研究使用了多种 IIG 系统。一项符合 II 级证据标准的研究比较了眼眶骨折修复术有 IIG（n=29）和无 IIG（n=29）的结果。在 IIG 组中报告了略好的结果：复视发生率为 2%比 10%（P=0.039），眼球内陷发生率为 3%比 10%（P=0.065）。另一项 II 级研究比较了导航（n=20）和无导航（n=20）下骨折修复的情况。使用导航的组平均体积减少 3.82cm，而无导航的组减少 3.33cm（P=0.02），导航组的眼球内陷测量减少 0.72mm（P=0.001）。尽管其余 30 项评估文章未达到 II 级标准，但均声称 IIG 有获益。未报告并发症。
少数比较研究表明，在眼眶骨折修复中使用 IIG 可改善结果，但每项研究都存在各种局限性。没有高质量的比较研究来评估泪道手术、肿瘤疾病或减压的管理。尚未确定归因于 IIG 使用的并发症，也未对 IIG 的成本节约进行分析。
参考文献之后可能会发现专有或商业披露。
