In this video, I'll demonstrate the use of intra-op navigation during late enophthalmos repair. By placing the navigation tip on any structure, this allows the surgeon to know in real time where they are at any point in the case. This includes determining the extent of posterior dissection as the dissection proceeds and also allows the surgeon to confirm specific landmarks such as the posterior ledge. Once the implant is in position, the surgeon can also confirm implant position as well as globe projection. There are a number of different navigation modalities. This one here uses an LED based technology. The tracker is placed on the patient's face and then registered to the navigation system. If you want to see where you are at any point, you can introduce a navigation device and slide it along the orbital wall or within the defect to see exactly where you are at any point in time. You can see here how close you are to the orbital apex. The surgeon should be very careful in this area. The navigation can allow you to identify the posterior ledge and tells you how aggressive you can be and how far you can go. When you look at the implant, you can see how much higher it sits versus the previous orbital defect. You can see when you skate the probe along the implant, you can get an idea of where the implant is sitting all the way posteriorly, which is very important. The next thing to check here is how I actually improve the degree of ocular projection. Remember the patient has a corneal shield contact lens in place to protect the eye. When you look at the actual views, you can see how much higher the position of the eyeball is now and how much more projected the eyeball is compared to where it was before.

intra-operative navigation

enophthalmos repair

LED technology

implant positioning

orbital apex