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In this paper the authors describe the growing use of computer-assisted surgery in ophthalmology. It is already described as a powerful adjunct in neurosurgery and sinus surgery and here they describe their experience of using it for the orbit; specifically for orbital decompression in thyroid eye disease (TED), repairing fractures, and excising orbital tumours. They describe the technology as being particularly useful for bony landmarks and for assistance with navigation around danger zones i.e. anatomical variation of neurovascular structures. In addition to this, the ability of CT-MRI fusion allows for enhanced visualisation of soft tissue which is stated to be useful for surgical planning. The authors used computer-assisted surgery (CAS) in 19.6% of orbital surgeries over a five-year period and describe pitfalls of infrequent use resulting in the equipment being a potential source of distraction during complex cases, although this is not their own experience. The authors describe requiring an additional 20 minutes per case in the learning phase of using the equipment; this can later be reduced to 10 minutes with extensive experience. Cost of equipment will inevitably present as a factor in uptake and integration into an ophthalmology unit, particularly in government-funded health systems.

Use of computer-assisted surgery in the orbit.
Campbell AA, Mahoney NR.
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Hetvi Bhatt

Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.

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