Purpose

To report the feasibility and potential utility of mixed reality (MR)-assisted support in orbitotomy for preoperative planning and intraoperative anatomical orientation.

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Methods

This pilot case series included 3 consecutive patients who underwent 4 orbitotomy procedures with MR-assisted support at a tertiary referral centre in Hong Kong between December 2025 and February 2026. Preoperative high-resolution contrast-enhanced CT and MRI dataset were registered for three-dimensional segmentation, and MR holographic reconstruction. MR-assisted preoperative surgical planning, patient-specific holographic reconstruction, intraoperative hologram-to-patient registration, and anatomical orientation using headset-based visualization.

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Results

Three patients (2 males; mean age, 55 years) underwent four MR-assisted orbital surgeries. One patient with sebaceous gland carcinoma with orbital extension underwent margin-controlled excisional biopsy followed by second-stage intraorbital brachytherapy applicator insertion through lateral orbitotomy. Two patients presented with superonasal intraconal and inferonasal intraconal cavernous venous malformations associated with compressive optic neuropathy and underwent superior orbitotomy or transcaruncular orbitotomy. MR-assisted visualization was successfully incorporated into all procedures for preoperative planning and intraoperative anatomical referencing. Hologram-to-patient registration was successfully achieved with satisfactory anatomical accuracy in all cases. No dizziness or intolerance related to MR headset use was reported by surgeons intraoperatively. Clinical outcomes were favourable in all cases, with reversal of optic neuropathy in two patients. No intraoperative complications were encountered, and no recurrence was observed in the patient with sebaceous gland carcinoma at 3 months following orbital brachytherapy.

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Conclusion

This pilot study demonstrates the feasibility of MR-assisted support in orbitotomy and established proof of concept for its use in orbital surgery.

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Additional Authors

First name	Last name	Base Hospital / Institution
Kelvin	Chong	CUHK
Ajax	Lau	PWH
Kwok Chuen	Wong	PWH
Clement	Tham	CUHK

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