The Role of Computer-Assisted Technology in Post-Traumatic Orbital Reconstruction: A PRISMA-driven Systematic Review

Post-traumatic orbital reconstruction remains a surgical challenge and requires careful preoperative planning, sound anatomical knowledge and good intraoperative judgment. Computer-assisted technology has the potential to reduce error and subjectivity in the management of these complex injuries. A systematic review of the literature was conducted to explore the emerging role of computer-assisted technologies in post-traumatic orbital reconstruction, in terms of functional and safety outcomes. We searched for articles comparing computer-assisted procedures with conventional surgery and studied outcomes on diplopia, enophthalmos, or procedure-related complications. Six observational studies with 273 orbits at a mean follow-up of 13 months were included. Three out of 4 studies reported significantly fewer patients with residual diplopia in the computer-assisted group, while only 1 of the 5 studies reported better improvement in enophthalmos in the assisted group. Types and incidence of complications were comparable. Study heterogeneities limiting statistical comparison by meta-analysis will be discussed. This review highlights the scarcity of data on computer-assisted technology in orbital reconstruction. The result suggests that computer-assisted technology may offer potential advantage in treating diplopia while its role remains to be confirmed in enophthalmos. Additional well-designed and powered randomized controlled trials are much needed.


Rationale
3 Describe the rationale for the review in the context of what is already known.

3
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS).

METHODS
Protocol and registration 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number.

N/A
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale.

4
Information sources 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched.

4-5
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated.

Appendix 1
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis).

5
Data collection process 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators.

5
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made.

Risk of bias in individual studies
12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis.

6
Additional analyses 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were pre-specified.

Study selection
17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram.

Figure 1
Study characteristics 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations. Tables  1,2 Risk of bias within studies 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). Table 3 Results of individual studies 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group (b) effect estimates and confidence intervals, ideally with a forest plot. Tables  4,5 Synthesis

DISCUSSION
Summary of evidence 24 Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers).

10-12
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias).

9-11
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future research.

12-13
FUNDING Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review.