The use of Computer-Aided Design/ Computer-Aided Manufacturing technologies in the treatment of Graves' orbitopathy

Abstract

Purpose To study the advantages of using Computer-Aided Design (CAD)/Computer-Aided Manufacturing (CAM) technologies in the treatment of Graves Orbitopathy (GO).

Methods Research analysis of contemporary scientific medical publications on the subject, The 2018 European Group on Graves ‘Orbitopathy Guidelines for the Management of Graves’ Orbitopathy (EUGOGO), Philips Diamond Select Brilliance CT64, software environment Sim Plant 13.02 and Geomagic Freeform Plus.

Results Graves Orbitopathy (GO) is an autoimmune disease that results in dysteroid optic neuropathy (DON) in 3–5% of patients and progressive vision loss. According to the recommendations of EUGOGO 2018, orbital decompression is performed at the first stage of surgical treatment as scheduled with moderate inactive GO or immediately in patients with DON and/or rupture of the cornea with the involvement of a multidisciplinary team of radiodiagnosis, endocrinologist, ophthalmologist and maxillofacial surgeon. To increase the volume of bone orbit, surgeons extend the medial, lateral walls of the orbit, or the floor of the orbit, and remove a certain amount of infraorbital fat, but the only correct approach to date has not been determined (EUGOGO 2016). Given the need for an individual approach to the patient, the use of CAD/CAM technology to obtain three-dimensional models of the skull expands the ability to study the features of the anatomy of the walls of the orbit, its volume, planning of surgery.

Conclusions The result of a carefully planned orbit decompression using CAD/CAM technology is not only the reduction of intraocular pressure and exophthalmos for optimal treatment, but also the reduction of intraoperative complications (traumatization of the neurovascular bundles, muscles, etc.), shortening the duration of surgery.