Heads-Up 3D Surgery under Low Light Intensity Conditions: New High-Sensitivity HD Camera for Ophthalmological Microscopes.

Celso Soiti Matsumoto,Jun Makita,Kei Shinoda,Takuhei Shoji,Harue Matsumoto,Masayuki Shibuya,Hisato Ohno

doi:10.1155/2019/5013463

Celso Soiti Matsumoto, Jun Makita + Show 5 more

Open Access

https://doi.org/10.1155/2019/5013463

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Abstract

Purpose To determine the feasibility of performing intraocular surgeries in a heads-up position with low illuminance conditions by observing a display of the surgical field created by a three-dimensional imaging (3D) system. Methods Seventy-four eyes of 56 patients underwent cataract surgery (72 eyes) with the heads-up 3D surgery system; 60 eyes with cataract surgery alone, 7 eyes with combined cataract and glaucoma microdevice implant surgery, 5 eyes with combined cataract and vitrectomy surgery, and two eyes with vitrectomy surgery alone were studied. The illuminance from the surgical microscope was set to be dimmer (Leica M822F40 main light 2%; otto-flex 6%) than the usual setting to minimize the discomfort and glare for the patient. The surgeries were performed under topical anesthesia. The luminance of the images observed through the eyepieces of the operating microscope and the image of a 3D system created by a high-sensitivity sensor Exmor R 3CMOS HD camera (Sony MCC-1000MD) were measured. Results All surgeries were completed without any complications under the low illumination conditions. The surgical field on the display monitor was created by a 3D system using a high-sensitivity sensor camera and was observed in a heads-up position. The patients did not report any intolerable discomfort or glare during the surgery. Cataract surgeries were performed with a good view of the surgical field under the extremely low illumination from the surgical microscope. The high-sensitivity sensors and electronic amplifications of the image signals made the surgical field brighter and allowed the surgeon to perform the surgery confidently and safely. Conclusions Heads-up, 3D-assisted intraocular surgeries can be performed safely and efficiently with low illuminance of the surgical field. This trial is registered with UMIN000037838.

Highlights

Earlier studies have reported that the “heads-up surgery” method was well suited for cataract and vitreoretinal surgery, and it is expected that this method will become more widely used with further technical improvements [1,2,3]. e term heads-up surgery was introduced in earlier clinical studies, and it meant that the surgeon performs surgery by viewing the image of the surgical field created on a threedimensional display screen in a heads-up position and not by looking down through the microscope eyepieces
Surgical microscopes for ophthalmology have been improved in many ways, e.g., the use of 0-degree light beams to reduce the level of retroillumination, static laser filters, navigation systems for cataract surgeries, intraoperative OCT recordings and viewing, and laser filters in the microscope optical pathway. ese alterations will result in a significant reduction in the brightness of the surgical field even though surgeons prefer to increase the luminance of the surgical field
Heads-up, 3D digital surgery has many advantages over the conventional method including the increase of depth of focus, digital amplification of the image signal, better ergonomics for the surgeons, and live 3D view for all operation room staff

Summary

Introduction

Earlier studies have reported that the “heads-up surgery” method was well suited for cataract and vitreoretinal surgery, and it is expected that this method will become more widely used with further technical improvements [1,2,3]. e term heads-up surgery was introduced in earlier clinical studies, and it meant that the surgeon performs surgery by viewing the image of the surgical field created on a threedimensional display screen in a heads-up position and not by looking down through the microscope eyepieces. Earlier studies have reported that the “heads-up surgery” method was well suited for cataract and vitreoretinal surgery, and it is expected that this method will become more widely used with further technical improvements [1,2,3]. E term heads-up surgery was introduced in earlier clinical studies, and it meant that the surgeon performs surgery by viewing the image of the surgical field created on a threedimensional display screen in a heads-up position and not by looking down through the microscope eyepieces. DAS with extremely high-sensitivity cameras can amplify the image signals and allow a brighter surgical field for surgeons in low luminance conditions of the microscope light

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