Minimally invasive measurement of orbital compartment pressure and implications for orbital compartment syndrome: a pilot study

Enz, Tim J; Papazoglou, Anthia; Tappeiner, Christoph; Menke, Marcel N.; Benitez, Benito K.; Tschopp, Markus

doi:10.1007/s00417-021-05222-z

Cited by 7 publications

(30 citation statements)

References 29 publications

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“…After the removal of duplications and title and abstract screening, a total of 66 articles remained. Next, full texts were thoroughly checked for eligibility and references were screened for additional publications of interest, resulting in a total of 20 articles from 1985 to 2021 for the final inclusion [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. The reviewed papers and main data are shown in Table S1 .…”

Section: Resultsmentioning

confidence: 99%

“…Four articles reported studies using animals (New Zealand white rabbits, goats, Macaca fascicularis monkeys, and Yorkshire piglets) [ 13 , 14 , 15 , 21 ] and seven studies used human cadaver heads for experiments [ 11 , 17 , 18 , 20 , 24 , 26 , 28 ]. Only nine articles reported direct OCP measurements in living humans [ 8 , 9 , 10 , 12 , 16 , 19 , 22 , 23 , 27 ]. Of these, four articles reported pressure measurements during major orbital surgery [ 8 , 16 , 19 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Of these, four articles reported pressure measurements during major orbital surgery [ 8 , 16 , 19 , 27 ]. Five articles reported minimally invasive measurements in an outpatient setting, two of them by the same group of investigators [ 9 , 10 , 12 , 22 , 23 ].…”

Section: Resultsmentioning

confidence: 99%

“…A total of 167 patients (219 orbits) were enrolled in the nine studies on living humans. Mostly, these studies were conducted either to test for feasibility of measuring devices or to assess OCP dynamics in orbital compartment syndrome or thyroid eye disease before or following orbital decompression [ 8 , 9 , 10 , 12 , 16 , 19 , 22 , 23 , 27 ].…”

Section: Resultsmentioning

confidence: 99%

“…Historically, an assessment of the tissue resistance provoked by the retropulsion of the eye bulb was the method of choice for estimating OCP, either by digital palpation or with specifically designed devices [ 6 , 7 ]. Today, with widely experimental methods [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ], the direct measurement of OCP is considered technically feasible yet impractical in a clinical setting due to limited availability, difficult arrangement, and invasiveness. Thus, in suspected orbital compartment syndrome, for example, OCP is generally not measured directly.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Orbital Compartment Pressure: A Comprehensive Review

Enz

Tschopp

2022

Diagnostics

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The orbit is a closed compartment defined by the orbital bones and the orbital septum. Some diseases of the orbit and the optic nerve are associated with an increased orbital compartment pressure (OCP), e.g., retrobulbar hemorrhage or thyroid eye disease. Our aim was to review the literature on the different approaches to assess OCP. Historically, an assessment of the tissue resistance provoked by the retropulsion of the eye bulb was the method of choice for estimating OCP, either by digital palpation or with specifically designed devices. We found a total of 20 articles reporting direct OCP measurement in animals, cadavers and humans. In nine studies, OCP was directly measured in humans, of which five used a minimally invasive approach. Two groups used experimental/custom devices, whilst the others applied commercially available devices commonly used for monitoring the compartment syndromes of the limbs. None of the nine articles on direct OCP measurements in humans reported complications. Today, OCP is mainly estimated using clinical findings considered surrogates, e.g., elevated intraocular pressure or proptosis. These diagnostic markers appear to reliably indicate elevated OCP. However, particularly minimally invasive approaches show promises for direct OCP measurements. In the future, more sophisticated, specifically designed equipment might allow for even better and safer measurements and hence facilitate the diagnosis and monitoring of orbital diseases.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of Orbital Compartment Pressure: A Comprehensive Review

Enz

Tschopp

2022

Diagnostics

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Orbitale Erkrankungen in der Neuroophthalmologie

Schittkowski

2023

Neuroophthalmologie

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Structural Limits of Orbital Compliance and Treatment Options for Pathologic Orbital Pressure

Chelnis

Kim

Meador

et al. 2023

Ophthalmic Plastic &Amp; Reconstructive Surgery

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Purpose: The integrity of the orbit has a finite structural limit due to the compliance of its tissue. The authors investigate these limits to quantify them and inform the treatment of heightened ocular and orbital pressure. Methods: Cadaveric study with 12 orbits being volumized before randomization of treatment for pathologic levels of ocular and orbital pressure. First-line and second-line treatment was chosen randomly (lateral cantholysis, superior septolysis, inferior septolysis). Prior to treatment, IOP, orbital compartment pressure, and axial globe projection was measured after delivery of each 1cc aliquot and surgical treatment. Results: Orbital compartment pressure and IOP were well correlated (r = 0.99). The average reduction in IOP after treatment averaged a 56.2 mm Hg reduction in IOP. All treatments were statistically equivalent (p < 0.01). Loss of compliance (PLOC) was determined when the mean plus 1 standard deviation of change in IOP/ml volume was achieved with simultaneous change in exophthalmometry of <0.5 mm change/ml added volume, indicating an acceleration in pressure in the face of a steady volume. This criteria was met for 11 of 12 orbits. The 12th orbit missed this threshold by 1 mm Hg in IOP. PLOC occurred at an average IOP of 43.0 mm Hg (±5.8 mm Hg, 90% CI) and after an average injection of 13 ml (±1.4 mm, 90% CI). Additionally, lateral cantholysis, superior septolysis, and inferior septolysis were statistically equivalent in reducing IOP after PLOC. Conclusions: IOP and orbital compartment pressure are excellent proxies for each other in the authors’ model. Orbital compliance is a mathematic phenomenon that can be quantified, as evident in this investigation. PLOC can inform timing for orbital decompressions in the presence of heightened IOP. Multiple procedures can be used to extinguish dangerously high orbital compartment pressure.

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Minimally invasive measurement of orbital compartment pressure and implications for orbital compartment syndrome: a pilot study

Cited by 7 publications

References 29 publications

Assessment of Orbital Compartment Pressure: A Comprehensive Review

Assessment of Orbital Compartment Pressure: A Comprehensive Review

Orbitale Erkrankungen in der Neuroophthalmologie

Structural Limits of Orbital Compliance and Treatment Options for Pathologic Orbital Pressure

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