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   Table of Contents      
COMMENTARY
Year : 2019  |  Volume : 67  |  Issue : 5  |  Page : 664

Commentary: Relevance of orbital measurements for the orbit surgeon


Cosultant Orbit and Oculoplasty Surgeon, Manipal Hospital, Bangalore, Karnataka, India

Date of Web Publication22-Apr-2019

Correspondence Address:
Dr. Lakshmi Mahesh
Cosultant Orbit and Oculoplasty Surgeon, Manipal Hospital, Bangalore, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijo.IJO_690_19

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How to cite this article:
Mahesh L. Commentary: Relevance of orbital measurements for the orbit surgeon. Indian J Ophthalmol 2019;67:664

How to cite this URL:
Mahesh L. Commentary: Relevance of orbital measurements for the orbit surgeon. Indian J Ophthalmol [serial online] 2019 [cited 2019 May 19];67:664. Available from: http://www.ijo.in/text.asp?2019/67/5/664/256689



First of all, the authors should be congratulated for bringing out such a systematic study. They have very rightly reiterated its need especially for the Indian population.

We all agree that the usefulness of such a study will be its ultimate clinical application in the practicality and appropriate surgical planning. As orbital surgeons, we rely on imaging to a great extent especially in cases of Thyroid Eye Disease (TED) and Dysthyroid Optic Neuropathy where orbital decompression is warranted.[1],[2]

One wonders whether the bone density could play a role because the dimensions in this study were higher compared to Dr Dhanwate's study on dry skulls.[3] It could be recommended to use thin slices preferably in the helical mode when selective CT orbit acquisition is done and enabling 3D reconstruction would mimic a dry bone study to an extent.

Alternatively, a few limited MRI sequences may be taken which would in addition to the morphology give information on the signal changes in the extra ocular muscles, orbital fat and so on. It could also clearly delineate between the optic nerve and its sheath which may prevent misinterpretation based only on optic nerve sheath complex noted on CT scan. For instance, optic atrophy may not be picked up on CT scan as it would be replaced by the CSF sleeve. The surgeon's confidence in diagnosing and planning an optic nerve sheath fenestration becomes manifold when one has the knowledge of the dimensions in the given patient versus normative data. We have noted that there can be significant muscle thickening and compression of the optic nerve even without increased proptosis as Asian Indian orbits tend to behave more tight in the TED process. This would be more in the South Indian population as the Orbital Indices are smaller when compared with Dr Dhanwate's study.[4] Normative indices would also help for surgical planning of slow growing orbital tumours and asking for these measurements in our radiological requisitions routinely would be worthwhile.[5]

Navigation-assisted orbital surgery and possible robotic orbital surgery in future could play a pivotal role and would certainly require these parameters. However, the ultimate importance of such data is to safe guard the vision with respect to the optic nerve function whatever the disease aetiology is.



 
  References Top

1.
Gonçalves AC, Silva LN, Gebrim EM, Matayoshi S, Monteiro ML. Predicting dysthyroid optic neuropathy using computed tomography volumetric analyses of orbital structures. Clinics (Sao Paulo) 2012;67(8):891-6.  Back to cited text no. 1
    
2.
Gonçalves AC, Silva LN, Gebrim EM, Monteiro ML. Quantification of orbital apex crowding for screening of dysthyroid optic neuropathy using multidetector CT. AJNR Am J Neuroradiol 2012;33:1602-7.  Back to cited text no. 2
    
3.
Dhanwate AD, Gaikwad MD. Morphometric analysis of orbit in Indian skulls and comparison with international studies. Int J Anat Res 2016;4:2896.  Back to cited text no. 3
    
4.
Patil GV, Shishirkumar, Thejeswari, Apoorva D, Sharif J, Sheshgiri C, et al. Study of orbital index in human dry skulls of South Indian origin. IJHSR 2014;4:125-8.  Back to cited text no. 4
    
5.
Gupta V, Prabhakar A, Yadav M, Khandelwal N. Computed tomography imaging-based normative orbital measurement in Indian population. Indian J Ophthalmol 2019;67:659-63.  Back to cited text no. 5
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