Accurate excision of orbital tumors continues to present a major surgical challenge. Near-infrared II (NIR-II) fluorescence imaging offers surgeons the possibility of real-time visualization and localization of these tumors. This study represents the first evaluation of the feasibility and potential clinical benefit of NIR-II fluorescence imaging during orbital tumor resection. A dedicated NIR-II fluorescence imaging platform was constructed, with indocyanine green (ICG) utilized as the fluorescent contrast agent. Twenty-two patients with diagnosed orbital tumors scheduled for conventional surgery participated in the investigation. Time-dependent NIR-II imaging performed in two individuals with superficial orbital tumors established that the most suitable imaging interval was 2 h following ICG injection. In fifteen patients evaluated for diagnostic performance, both intraoperative in situ and ex vivo NIR-II fluorescence imaging demonstrated higher sensitivity and specificity than the operating surgeon’s visual and tactile assessment. In the feasibility phase involving the remaining five patients, surgeons identified 34 regions of uncertainty and altered their operative plan on nine occasions based on NIR-II fluorescence guidance. Seven additional tissue resections guided by fluorescence were subsequently confirmed as appropriate by histopathological analysis, while two decisions to refrain from further excision resulted in no tumor recurrence. These outcomes support the conclusion that ICG-assisted NIR-II fluorescence imaging is a practical technique for facilitating precise resection of orbital tumors. Larger randomized controlled studies are recommended to confirm its broader clinical effectiveness.
