Interactive navigation-guided ophthalmic plastic surgery: The techniques and utility of 3-dimensional navigation

• Published in: Canadian journal of ophthalmology Vol. 52; no. 3; pp. 250 - 257
• Main Authors: Ali, Mohammad Javed, FRCS, Naik, Milind N., MD, Kaliki, Swathi, MD, Dave, Tarjani Vivek, MD, Dendukuri, Gautam, FDSRCS
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-06-2017
• Subjects: Adult; Eye Diseases - diagnosis; Eye Diseases - surgery; Female; Humans; Imaging, Three-Dimensional - utilization; Internal Medicine; Male; Ophthalmologic Surgical Procedures - methods; Ophthalmology; Prospective Studies; Reconstructive Surgical Procedures - methods; Surgery, Computer-Assisted - utilization; Young Adult
• ISSN: 0008-4182; 1715-3360
• DOI: 10.1016/j.jcjo.2016.10.012

Abstract Purpose To demonstrate the techniques and utility of 3-dimensional reconstruction (3DR) of the target pathologies for subsequent navigation guidance in ophthalmic plastic surgery. Study design Prospective interventional case series. Methods Stereotactic surgeries using 3D reconstruction of target lesions as the intraoperative image-guiding tool were performed in 5 patients with varied etiopathologies. All the surgeries were performed using the intraoperative image-guided StealthStation system in the electromagnetic mode. 3DR was performed using StealthStation 3D model software. The utility of 3D reconstruction for extensive orbital mass lesions, large orbital fractures, intraconal foreign body, and delineation of perilesional intricate structures was studied. The intraoperative ease and usefulness for the navigation of a 3D lesion at crucial phases of the surgery were noted. Results Intraoperative geometric localization of the 3D lesions was found to be enhanced and precise. 3D reconstruction of the lesion along with the major vessels and nerves in the vicinity helped the surgeon to prevent potential injuries to these structures. The fracture defects could be navigated in a 3D plane and this helped in moderate customization of the implants intraoperatively. Foreign body located in difficult access positions could be accurately targeted for geometric localization before safe retrieval. Detailed preoperative 3D reconstruction by the surgeon was found to be beneficial for successful outcomes. Conclusions Three-dimensional navigation is very useful in providing detailed anatomical delineation of the targets and enhances the precision in certain complex cases in ophthalmic plastic surgery.