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Vital Signs

Spring 2011

Small-Incision Eye-Tumor Surgery Minimizes Scarring, Pain


VS-Spring2011-Eye Tumor SurgeryTumors around the eye are a rare but potentially devastating problem that may eventually lead to permanent vision loss, eye removal or death. Treatment depends on the type of tumor and its location next to the eye. In patients with relatively small tumors that have not spread, cancer can often be removed using small-incision eye surgery that not only saves vision, but also minimizes scarring and pain.

“Before we developed smaller incision techniques, these tumors were taken out through a large incision in the eyebrow or through a long incision across the face, which left a scar from ear to ear,” says Robert A. Goldberg, M.D., chief of orbital and ophthalmic plastic surgery and co-director of the aesthetic reconstructive surgery service at the UCLA Jules Stein Eye Institute (JSEI). In addition, he says, large segments of bone are usually removed during conventional surgeries, which require patients to be placed under general anesthesia for several hours. The operations frequently cause significant blood loss and pain, and may damage tissue that affects nerves and muscle around the eye. Patients are often hospitalized following the procedure, Dr. Goldberg says.

Unlike the conventional procedure, small-incision, or minimally invasive, eye-tumor surgery is performed through a small, hidden cut in the back of the eyelid or in the eyelid crease. It is an outpatient procedure, often performed under local anesthesia. Eye surgeons use advanced orbital imaging technologies, newer vascular studies and small, specialized instruments to view and dissect the tumor from surrounding tissue. The tumor is often drained of blood or fluid or collapsed in some other way so that the mass may be carefully removed through the small incision.

“We have to be inventive and individualize our approach for each case because we’re operating in a space behind the eye socket about the size of a walnut,” Dr. Goldberg says. “The tumor is often next to the optic nerve or the dura of the brain, which complicates the surgery and may require us to make adjustments during the procedure.”

According to Dr. Goldberg, surgeons at UCLA have used the small-incision approach to remove orbital tumors almost exclusively for the past 10 years, though these surgeries must sometimes be converted to large-incision operations in more difficult cases. He says the minimally invasive procedures carry some additional risks, including possible damage to the nerves or eye muscle because the smaller incision limits the surgeon’s view of the eye. Still, he says the complication rate at UCLA is extremely low compared to national averages and, for most patients, the benefits of the small-incision approach outweigh the risks.

“People care about having scars on their faces, and they want to get back to work quickly,” he says. “If we can limit disfigurement and pain, the whole experience is better for patients psychologically, and they heal better as a result.”

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