Tuesday, July 13, 1999

By George F. Lee, Star-Bulletin
Taitaifono Otineru of American Samoa suffered a fractured eye
socket and nerve damage during a robbery of her home. She came
to Hawaii where she underwent groundbreaking surgery
at St. Francis Medical Center.

Seeing surgeons’
work on patients
is believing

At St. Francis, a device used
to operate on sinuses is applied
to eye problems

By Helen Altonn


Patients of two Hawaii surgeons are benefiting from technology used during the Gulf War and Yugoslavian conflict to achieve pinpoint accuracy in bombing their targets.

One is Taitaifono Otineru, 55, of American Samoa, who had surgery last Thursday at St. Francis Medical Center for broken bones in her left eye socket and a damaged nerve in her eyelid.

She was assaulted during a robbery of her home in March. "My eye was broken," she said. She could still see, but her eye had "slightly dropped," and her vision was poor, she said.

Otineru must wear an eye patch while her eye recovers from the surgery. But when she changes it, she said, "Now, I can see great."

Ophthalmologist Jorge Camara used a device called InstaTrak to repair the fractures to Otineru's left eye and the damaged nerve.

Possible breakthrough

Based on medical literature and information from the manufacturer, Camara believes he's the first in the world to use the computer-image guiding machine for such surgery.

St. Francis Medical Center purchased the InstaTrak after Dr. Roland Tam, an otolaryngologist (ear, nose throat specialist), saw a colleague using it on the mainland for sinus surgery.

"It's a fantastic bit of equipment," Tam said. He learned about it while attending courses on the mainland by Dr. Reuben Setliff, one of the country's foremost sinus surgeons, he said.

Tam was so impressed with its advantages for safer, more efficient sinus surgery that he talked to St. Francis about getting one.

He performed the first computer image-guided sinus surgery in Hawaii last November. Camara wasn't far behind.

Sinus surgeons must be careful not to enter the socket of the eye or cause damage to the nerves, especially of the eye, which is right beside the sinuses, Camara pointed out.

"I immediately got the idea if they used this to prevent complications in this area, why in the world can't orbital surgeons use it for the same reason?"

Multiple applications

He contacted the company to ask if any surgeons had used the machine for eye surgery and none had, he said. "I proceeded to develop some guidelines for its use in ophthalmology.

"It's so exciting," Camara said, describing how InstaTrak permits precise surgery for a wide spectrum of eye problems, including orbital decompressions, fractures, tumors and abscesses.

His first case came last December creating a fracture to push the socket back into the eye for a patient with bulging eyes due to thyroid disease.

Using InstaTrak cut the surgery time by at least 30 to 45 minutes, he said.

"There was much less surgical dissection, which led to less surgical trauma to the patient and faster recovery," Camara said.

In Otineru's case, he said three of the four walls of her eye socket were fractured and her eye was sinking inward.

Otineru, staying with relatives at Schofield Barracks, said she was hospitalized for a week in American Samoa after she was beaten.

She thought everything was OK and her eye would slowly heal, but she was still having dizzy spells, she said. In May, doctors there referred her to Hawaii for further treatment. Doctors here referred here to Camara, she said.

She said she's "much, much better" since the surgery.

She's remaining in Hawaii for an eye checkup July 16. She's also anxious to see her daughter Meghann, 20, a University of Hawaii student now in Washington, D.C., as a congressional intern. She's due back Aug. 6.

Tam said InstaTrak allows surgeons to see the exact position of surgical instruments and track their movements as they're doing surgery instead of relying on hard copies of CAT scans and an "intuitive process."

"It gives a surgeon a much clearer idea of anatomy," he said, explaining that a three-dimensional view can be obtained with a few clicks of the computer mouse.

"Another powerful thing is we see every layer ... every last cubic millimeter we want to see or explore on the computer," he said.

"After doing that, we have a pretty good idea what operation or operations would be necessary or desired to help the patient."

Bigger picture

Ophthalmologists also rely on CAT scans and experience to guide them in orbital surgery, Camara said. Normally, he said, they're afraid of injuring structures within the eye socket or of entering the adjacent sinuses or brain.

For example, he said, "If you're driving a car, you can clearly see where you are on the street from your window. What you don't know is what streets are to the right and to the left -- the relationship to the whole area."

InstaTrak provides a more comprehensive view, he said, likening it to the Global Positioning System used in some state-of-the-art automobiles.

"It allows me to see exactly where I am in relationship to other structures in the eye and adjacent to it," Camara said.

Camara says he looks forward to sharing information about InstaTrak at an annual meeting of ophthalmologists in the fall.

"It is very similar to using a word processor," Camara added. "Once you have used one, it is difficult to go back to a typewriter."

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