Abstract
Purpose: To assess the efficacy and outcomes of 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment using a three-dimensional heads-up display (3D HUD) surgical platform as compared to a standard operating microscope (SOM) setting.Design: Retrospective cohort study.Participants: One hundred and forty consecutive eyes of 140 patients with primary retinal detachment.Methods: All eyes underwent 23-gauge pars plana vitrectomy for primary retinal detachment using either a 3D HUD (NGENUITY; Alcon Inc., Fort Worth, Texas, USA; n = 70 eyes) or a SOM setting (n = 70 eyes); in cases of significant cataract, additional phacoemulsification with intraocular lens (IOL) implantation was performed. Minimum follow-up was 2 months.Main Outcome Measures: Primary retinal reattachment rate, rate of proliferative vitreoretinopathy (PVR), best-corrected visual acuity (BCVA), and duration of surgery.Results: There were 70 eyes each in the 3D HUD and the SOM group. Both groups did not differ concerning age (p = 0.70), extent of retinal detachment (p = 0.07), number of retinal tears (p = 0.40), macular involvement (p = 0.99), and preoperative BCVA (p = 0.99). Postoperatively, 3D HUD and SOM were comparable concerning the primary retinal reattachment rate (88.6 vs. 94.3%; p = 0.37), the development of postoperative PVR (12.9% vs. 7.1%; p = 0.40) and final BCVA (0.26 ± 0.40 vs. 0.21 ± 0.38 logMAR; p = 0.99). Duration of surgery was significantly longer in the 3D HUD group (66.2 ± 16.5 vs. 61.2 ± 17.1 min; p = 0.04), an effect which however vanished after a “learning curve” of the first 35 eyes (p = 0.49).Conclusions: On par results to a conventional operating microscope can be achieved with a 3D HUD setting when performing 23-gauge vitreoretinal surgery for rhegmatogenous retinal detachment, including the primary retinal reattachment rate, the incidence of postoperative PVR and final BCVA. However, duration of surgery might initially be slightly longer with 3D HUD, suggesting the effect of a learning curve.
Highlights
Despite major technological advancements in the medical field, there has been limited innovation in digital assisted ophthalmic surgery in the last decade
Besides intraoperative tracking for toric intraocular lens alignment displayed via a heads-up display (HUD) in one ocular [3], there has been none but minor digital amendments to the standard operating microscope (SOM)
In 55.7% (n = 39) of cases in the 3D HUD group and 62.9% (n = 44) of cases in the SOM group, vitrectomy was combined with cataract extraction and intraocular lens (IOL) implantation (p = 0.99)
Summary
Despite major technological advancements in the medical field, there has been limited innovation in digital assisted ophthalmic surgery in the last decade. Besides intraoperative tracking for toric intraocular lens alignment displayed via a heads-up display (HUD) in one ocular [3], there has been none but minor digital amendments to the standard operating microscope (SOM). The recent release of a three-dimensional heads-up display (3D HUD; NGENUITY; Alcon Inc., Fort Worth, Texas, USA) pursues an essentially different approach to visualize intraocular surgery by replacing the traditional oculars with a digital screen. Performing surgery with a 3D HUD can literally be performed “heads-up” with polarizing spectacles enabling a stereoscopic view of the surgical field that is captured via a 3D stereoscopic, high-definition digital video camera and displayed on a high-definition monitor. Further advantages pertain to the applicability of instant digital filters (e.g., to enhance vitreous visability) as well as the technology’s extensive teaching possibilities as the surgeon’s view is identical with the audience’s (e.g., fellows, nurses, and students)
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