Minimally Invasive Glaucoma Surgery (MIGS) using a 3D Digital Surgical Ophthalmic Exoscope

Abstract

Intraoperative positioning required for direct gonioscopy during minimally invasive glaucoma surgery (MIGS) can pose a challenge for the patient, the surgeon, and the surgical trainee. With traditional optical microscopy, the patient's head, the microscope, and the surgeon's oculars must all be adjusted to achieve an adequate view of the iridocorneal angle. Even then, the surgical view is often inferior for observing or assisting trainees. This video demonstrates several benefits of digital microscopy using the Beyeonics One™ Surgical Exoscope (Beyeonics Surgical, Israel) and an augmented reality (AR) 3D immersive headset. The digital exoscope can be triggered to auto tilt to facilitate direct gonioscopy. The degree to which the exoscope and the patient's head are adjusted may be less than what one traditionally requires with optical microscopy. Surgeon working distance should also be less affected. A digital recenter feature maintains a centered view without having to physically move the camera. The surgeon, who is wearing an immersive headset, does not have to move or adjust the oculars. The foot pedal or headset can be used for fine focus or zoom. The gonioscopic view is near identical to optical microscopy, but the digital technology and automation allow for improved ergonomics and enhanced visualization. A trainee can also don a headset for an identical view to the primary surgeon.