Advances in Minimally invasive oculoplastic surgery: Current Techniques and Outcomes: a systematic review
DOI:
https://doi.org/10.65759/8393we78Keywords:
Minimally invasive oculoplastic surgery, oculoplastic surgery, transconjunctival blepharoplasty, transconjunctival orbitotomy, endoscopic dacryocystorhinostomyAbstract
Background: Minimally invasive oculoplastic surgery (MIOS) aims to reduce scarring, tissue trauma, morbidity, and recovery time while preserving periocular function and cosmesis. Our systematic review synthesized techniques and outcomes in selected MIOS. Methods: A PRISMA-based systematic review was conducted using PubMed, Scopus, Web of Science, and Embase. Original studies evaluating MIOS with postoperative outcome data were included. Data on study characteristics, procedures, populations, follow-up, and outcomes were extracted and synthesized qualitatively because of heterogeneity. Results: Six eligible original studies were included, covering transconjunctival (TC) lower eyelid blepharoplasty, TC orbitotomy for intraconal orbital hydatid cysts, and endoscopic dacryocystorhinostomy (DCR). TC blepharoplasty showed good recovery, scar-free access, and low rates of major complications, with most short-term symptoms resolving within 1 to 2 weeks. TC orbitotomy had successful cyst removal in all reported cases, with early symptom improvement and no recurrence during follow-up. In endoscopic DCR studies, success rates were high, silicone tubing did not show significant benefit in primary cases, kerrison punch (K-punch) shortened operative time compared with powered drill, and the double-flap technique reduced recurrence compared with the single-flap technique. Conclusion: MIOS showed good effectiveness and safety in selected indications, and the data remained limited by small study numbers, retrospective designs, and heterogeneity.
References
1. Al-Qahtani AS. Primary endoscopic dacryocystorhinostomy with or without silicone tubing: A prospective randomized study. Am J Rhinol Allergy. 2012;26(4):332-4. doi: 10.2500/ajra.2012.26.3770.
2. Awad AA, Mohammad AEN. A simple transconjunctival technique for the management of intraconal orbital hydatid cyst. Indian J Ophthalmol. 2025;73(2):249-252. doi: 10.4103/IJO.IJO_756_24.
3. Bani-Ata M, Aleshawi A, Ahmad M, Saleh O, Ashour R, Khalil H, Alomari S, Alhowary AA. Endoscopic dacryocystorhinostomy: A comparison of double-flap and single-flap techniques. Ann Med Surg (Lond). 2020;54:1-5. doi: 10.1016/j.amsu.2020.03.003.
4. Bhattacharjee K, Ghosh S, Ugradar S, Azhdam AM. Lower eyelid blepharoplasty: an overview. Indian J Ophthalmol. 2020 Oct;68(10):2075-2083. doi: 10.4103/ijo.IJO_1291_20.
5. Eldsoky I, Ismaiel WF, Hasan A, Abdelazim MH, Ibrahim AA, Alsobky ME, Mohammed AR. The predictive value of nasolacrimal sac biopsy in endoscopic dacryocystorhinostomy. Ann Med Surg (Lond). 2021;65:102317. doi: 10.1016/j.amsu.2021.102317.
6. Gupta R, Khosa A, Bansal P, Chaudhury G. Exploring the Versatility of Transconjunctival Blepharoplasty: A Retrospective Single-Center Study. Cureus. 2024;16(11):e72929. doi: 10.7759/cureus.72929.
7. Herzallah I, Alzuraiqi B, Bawazeer N, Marglani O, Alherabi A, Mohamed SK, Al-Qahtani K, Al-Khatib T, Alghamdi A. Endoscopic Dacryocystorhinostomy (DCR): a comparative study between powered and non-powered technique. J Otolaryngol Head Neck Surg. 2015;44(1):56. doi: 10.1186/s40463-015-0109-z.
8. Jawaheer L, MacEwen CJ, Anijeet D. Endonasal versus external dacryocystorhinostomy for nasolacrimal duct obstruction. Cochrane Database Syst Rev. 2017 Feb 24;2(2):CD007097. doi: 10.1002/14651858.CD007097.pub3.
9. Korchia D, Braccini F, Paris J, Thomassin JM. Transconjunctival approach in lower eyelid blepharoplasty. Can J Plast Surg. 2003;11(3):166-70.
10. Kotb AN, Salamah MA, Khalil AS, Dessouky RAK. Outcomes of a novel algorithm for levator muscle plication surgery in congenital blepharoptosis. BMC Ophthalmol. 2024;24(1):22. doi: 10.1186/s12886-024-03287-y.
11. Liu S, Zhang H, Zhang YR, Chen LJ, Yu XY. The efficacy of endoscopic dacryocystorhinostomy in the treatment of dacryocystitis: A systematic review and meta-analysis. Medicine (Baltimore). 2024;103(13):e37312. doi: 10.1097/MD.0000000000037312.
12. Locatello LG, Redolfi De Zan E, Caiazza N, Tarantini A, Lanzetta P, Miani C. A critical update on endoscopic dacryocystorhinostomy. Acta Otorhinolaryngol Ital. 2024 Oct;44(5):351-360. doi: 10.14639/0392-100X-N2916.
13. Naik MN, Honavar SG, Das S, Desai S, Sendhilnathan S. Blepharoplasty: an overview. J Cutan Aesthet Surg. 2009 Jan;2(1):6-11. doi: 10.4103/0974-2077.53092.
14. Panda BB, Nayak B, Mohapatra S, Thakur S, Vishwanath S. Success and complications of endoscopic laser dacryocystorhinostomy vs. external dacryocystorhinostomy: A systematic review and meta-analysis. Indian J Ophthalmol. 2023;71(10):3290-3298. doi: 10.4103/IJO.IJO_3334_22.
15. Patel V, Malhotra R. Transconjunctival blepharoptosis surgery: a review of posterior approach ptosis surgery and posterior approach white-line advancement. Open Ophthalmol J. 2010;4:81-84. doi: 10.2174/1874364101004010081.
Tong JY, Sung J, Machado de Andrade W, Chan WO, Psaltis AJ, Selva D. An oculoplastic perspective on transorbital neuroendoscopic surgery: anatomical corridors and clinical applications. Taiwan J Ophthalmol. 2026;16(1):26-34. doi: 1
