1
|
Poh SSJ, Sia JT, Yip MYT, Tsai ASH, Lee SY, Tan GSW, Weng CY, Kadonosono K, Kim M, Yonekawa Y, Ho AC, Toth CA, Ting DSW. Artificial Intelligence, Digital Imaging, and Robotics Technologies for Surgical Vitreoretinal Diseases. Ophthalmol Retina 2024:S2468-6530(24)00044-7. [PMID: 38280425 DOI: 10.1016/j.oret.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/14/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVE To review recent technological advancement in imaging, surgical visualization, robotics technology, and the use of artificial intelligence in surgical vitreoretinal (VR) diseases. BACKGROUND Technological advancements in imaging enhance both preoperative and intraoperative management of surgical VR diseases. Widefield imaging in fundal photography and OCT can improve assessment of peripheral retinal disorders such as retinal detachments, degeneration, and tumors. OCT angiography provides a rapid and noninvasive imaging of the retinal and choroidal vasculature. Surgical visualization has also improved with intraoperative OCT providing a detailed real-time assessment of retinal layers to guide surgical decisions. Heads-up display and head-mounted display utilize 3-dimensional technology to provide surgeons with enhanced visual guidance and improved ergonomics during surgery. Intraocular robotics technology allows for greater surgical precision and is shown to be useful in retinal vein cannulation and subretinal drug delivery. In addition, deep learning techniques leverage on diverse data including widefield retinal photography and OCT for better predictive accuracy in classification, segmentation, and prognostication of many surgical VR diseases. CONCLUSION This review article summarized the latest updates in these areas and highlights the importance of continuous innovation and improvement in technology within the field. These advancements have the potential to reshape management of surgical VR diseases in the very near future and to ultimately improve patient care. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
Collapse
Affiliation(s)
- Stanley S J Poh
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Josh T Sia
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Michelle Y T Yip
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore
| | - Andrew S H Tsai
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Shu Yen Lee
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Gavin S W Tan
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
| | - Christina Y Weng
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas
| | | | - Min Kim
- Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Yoshihiro Yonekawa
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Allen C Ho
- Wills Eye Hospital, Mid Atlantic Retina, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Cynthia A Toth
- Departments of Ophthalmology and Biomedical Engineering, Duke University, Durham, North Carolina
| | - Daniel S W Ting
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore; Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore; Byers Eye Institute, Stanford University, Palo Alto, California.
| |
Collapse
|
2
|
Sandali O, Tahiri Joutei Hassani R, Dulière C, El Sanharawi M, Borderie V, Williams GA. Use of the Three-dimensional Viewing System and Microscope Tilting to Extend the Peripheral Retinal View. Retina 2023; 43:2109-2112. [PMID: 37983377 DOI: 10.1097/iae.0000000000003442] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe and evaluate the effectiveness of the microscope and lens tilting technique associated with the three-dimensional viewing system for improving the peripheral retinal view in noncontact lens vitreoretinal surgeries. METHODS Prospective, single-center, single-surgeon, consecutive case series of 25 patients undergoing vitrectomy for macular surgeries with three-dimensional visualization system. At the end of each surgery, the microscope and the noncontact lens were rotated by 20° in a direction opposite to the rotation of the eye to extend the peripheral visual field. RESULTS Microscope and lens tilting technique extended the edge of the peripheral viewing field relative to its position with the microscope untilted, by 1.72 mm (±0.37) for the superior retina and 1.93 mm (±0.42) for the inferior retina (P < 0.0001). The ora serrata was visualized in 33% and 0% of cases for the superior retina and 91% and 36% of cases for the inferior retina, in tilted and nontilted microscope positions, respectively (P < 0.01). CONCLUSION Microscope and lens tilting could be useful to extend the peripheral visual field of view in retinal surgery. The three-dimensional system allowed to maintain surgeon comfort and posture during surgery.
Collapse
Affiliation(s)
- Otman Sandali
- Centre Hospitalier National d'Ophtalmologie des XV-XX, Unit 5, Pierre & Marie Curie University, Research Team 968, Institut de la Vision, Paris, France
- Hôpital Guillaume-de-Varye, service de chirurgie ambulatoire, Bourges, France
| | | | - Cedric Dulière
- Hôpital Guillaume-de-Varye, service de chirurgie ambulatoire, Bourges, France
| | | | - Vincent Borderie
- Centre Hospitalier National d'Ophtalmologie des XV-XX, Unit 5, Pierre & Marie Curie University, Research Team 968, Institut de la Vision, Paris, France
| | - George A Williams
- Centre Hospitalier National d'Ophtalmologie des XV-XX, Unit 5, Pierre & Marie Curie University, Research Team 968, Institut de la Vision, Paris, France
- Hôpital Guillaume-de-Varye, service de chirurgie ambulatoire, Bourges, France
- Centre Hospitalier de Granville, service de chirurgie ambulatoire, Granville, France; and
- Centre Hospitalier de Châteaudun, service d'ophtalmologie, Châteaudun, France
| |
Collapse
|
3
|
Chen SN, Chen SJ, Wu TT, Wu WC, Yang CH, Yang CM. Refining vitrectomy for proliferative diabetic retinopathy. Graefes Arch Clin Exp Ophthalmol 2023; 261:3659-3670. [PMID: 37314522 PMCID: PMC10667443 DOI: 10.1007/s00417-023-06134-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
Pars plana vitrectomy (PPV) is the main treatment modality for patients with severe diabetic retinopathy. With the development of systems for microincision, wide-angle viewing, digitally assisted visualization, and intraoperative optical coherence tomography, contemporary PPV for diabetic retinopathy has been performed on a wider range of indications than previously considered. In this article, we reviewed, in conjunction with our collective experiences with Asian patients, the applications of new technologies for PPV in eyes with diabetic retinopathy and highlighted several important procedures and entities not generally reiterated in the literature, in order for vitreoretinal surgeons to optimize their approaches when facing the challenges imposed by the complications in diabetic eyes.
Collapse
Affiliation(s)
- San-Ni Chen
- Department of Ophthalmology, China Medical University Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan
| | - Shih-Jen Chen
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Tien Wu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Hao Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan
- School of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-May Yang
- Department of Ophthalmology, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei, 10002, Taiwan.
- School of Medicine, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
4
|
Zheng K, Zheng X, Wang J, Han Y, Wang X, Zhou X. The Implementation of Glasses-free 3D Display in ICL Surgery: A Pilot Study. J Refract Surg 2023; 39:612-619. [PMID: 37675913 DOI: 10.3928/1081597x-20230728-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
PURPOSE To compare the efficacy and safety of the glasses-free three-dimensional (3D) display and conventional optical microscope in Implantable Collamer Lens (ICL; STAAR Surgical) surgery. METHODS This randomized controlled trial enrolled 51 eyes of 26 patients who received ICL surgery. After random allocation, patients received surgery under either a glasses-free 3D display (16 eyes) or a conventional optical microscope (35 eyes). The surgical duration, uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), intraocular pressure, vault, postoperative manifest refraction spherical equivalent (MRSE), and complications were evaluated. RESULTS Mean surgical time was 5.04 ± 2.74 minutes for the glasses-free 3D group and 4.65 ± 2.63 minutes for the conventional microscope group (P = .639). Postoperative UDVA was -0.02 ± 0.04 and -0.04 ± 0.05 logMAR (P = .169), CDVA was -0.03 ± 0.04 and -0.02 ± 0.05 logMAR (P = .434), and IOP was 17.01 ± 3.15 and 14.82 ± 2.20 mm Hg (P = .055) at 1 month of follow-up, respectively. Vault was 562.86 ± 192.89 and 520.18 ± 215.19 µm, and MRSE was +0.25 ± 0.21 and +0.10 ± 0.51 diopters, respectively, at 1 month postoperatively; all were comparable between the glasses-free 3D group and conventional microscope group (all P > .05). No complication occurred in both groups. CONCLUSIONS The glasses-free 3D group achieved similar efficacy and safety compared to the conventional microscope group, and glasses-free 3D surgery is expected to show a significant advantage in clinical and medical education. [J Refract Surg. 2023;39(9):612-619.].
Collapse
|
5
|
Srinivasan S, Tripathi AB, Suryakumar R. Evolution of operating microscopes and development of 3D visualization systems for intraocular surgery. J Cataract Refract Surg 2023; 49:988-995. [PMID: 37144641 DOI: 10.1097/j.jcrs.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 05/02/2023] [Indexed: 05/06/2023]
Abstract
The recent development of high-resolution, heads-up, 3D visualization microscopy systems has provided new technical and visualization options for ophthalmic surgeons. In this review, we explore the evolution of microscope technologies, the science behind modern 3D visualization microscopy systems, and the practical benefits (as well as disadvantages) that these systems provide over conventional microscopes for intraocular surgical practice. Overall, modern 3D visualization systems reduce the requirements for artificial illumination and provide enhanced visualization and resolution of ocular structures, improving ergonomics, and facilitating a superior educational experience. Even when considering their disadvantages, such as those related to technical feasibility, 3D visualization systems have an overall positive benefit/risk ratio. It is hoped these systems will be adopted into routine clinical practice, pending further clinical evidence on the benefits they may provide on clinical outcomes.
Collapse
Affiliation(s)
- Sathish Srinivasan
- From the University Hospital Ayr, Ayr, Scotland, United Kingdom (Srinivasan); University of West of Scotland, Ayr, Scotland, United Kingdom (Srinivasan); Alcon Research LLC, Fort Worth, Texas (Tripathi, Suryakumar)
| | | | | |
Collapse
|
6
|
Razavi P, Cakir B, Baldwin G, D’Amico DJ, Miller JB. Heads-Up Three-Dimensional Viewing Systems in Vitreoretinal Surgery: An Updated Perspective. Clin Ophthalmol 2023; 17:2539-2552. [PMID: 37662647 PMCID: PMC10473403 DOI: 10.2147/opth.s424229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023] Open
Abstract
Three-Dimensional (3D) heads-up visualization systems have significantly advanced vitreoretinal surgery, providing enhanced detail and improved ergonomics. This review discusses the application of 3D systems in vitreoretinal surgery, their use in various procedures, their combination with other imaging modalities, and the role of this technology in medical education and telementoring. Furthermore, the review highlights the benefits of 3D systems, such as improved ergonomics, reduced phototoxicity, enhanced depth of field, and the use of color filters. Potential challenges, including the learning curve and additional costs, are also addressed. The review concludes by exploring promising future applications, including teleophthalmology for remote assistance and specialist availability expansion, virtual reality integration for global clinical education, and the combination of remotely robotic-guided surgery with artificial intelligence for precise, efficient surgical procedures. This comprehensive review offers insights into the current state and future potential of 3D heads-up visualization systems in vitreoretinal surgery, underscoring the transformative impact of this technology on ophthalmology.
Collapse
Affiliation(s)
- Peyman Razavi
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | | | - Donald J D’Amico
- Department of Ophthalmology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | |
Collapse
|
7
|
Gualino V, Pierne K, Manassero A, Bruneau S, Couturier A, Tadayoni R. Comparing microscope light-associated glare and comfort between heads-up 3D digital and conventional microscopes in cataract surgery: a randomised, multicentre, single-blind, controlled trial. BMJ Open Ophthalmol 2023; 8:e001272. [PMID: 37493673 PMCID: PMC10314628 DOI: 10.1136/bmjophth-2023-001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/27/2023] [Indexed: 07/27/2023] Open
Abstract
OBJECTIVE To compare subjective levels of comfort and visual experiences related to microscope light in patients undergoing their first cataract surgery with topical anaesthesia using a digital microscope (the NGENUITY three-dimensional (3D) visualisation system) or a conventional microscope. METHODS AND ANALYSIS A prospective, randomised, single-blinded, parallel-group, multicentre, interventional study. Patients (n=128) were randomly assigned to one of two treatment groups: the experimental group (n=63) had surgery using the digital microscope and the control group (n=65) had surgery with a conventional microscope. The primary outcome was patients' subjective experience of glare from the microscope light during surgery on a numerical scale from 0 to 10. Key secondary outcomes were patients' subjective levels of comfort and visual experiences related to the microscope light. RESULTS The experimental group reported significantly lower levels of glare; median levels were 1.0 (0.0-4.0) for the experimental group vs 3.0 (0.0-6.0) for the control group (p=0.027). They also reported higher levels of comfort; median ratings were 8.0 (6.5-10.0) in the experimental group and 7.0 (5.0-9.0) in controls (p=0.026). There were no group differences in ratings of subjective pain or visual disturbances. Median microscope light intensity was lower in the experimental group than controls; 3425.0 (2296.0-4300.0) Lux vs 24 279.0 (16 000.0-26 500.0) Lux (p<0.0001), respectively. CONCLUSION Compared with conventional microscopes, the NGENUITY 3D visualisation system allows surgeons to operate with lower levels of light exposure, resulting in significantly less glare and improved comfort in patients undergoing cataract surgery. TRIAL REGISTRATION NUMBER NCT05085314.
Collapse
Affiliation(s)
- Vincent Gualino
- Department of Ophthalmology, Clinique Honoré Cave, Montauban, France
| | - Kevin Pierne
- Department of Ophthalmology, Clinique Honoré Cave, Montauban, France
| | - Anthony Manassero
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
| | - Sébastien Bruneau
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
| | - Aude Couturier
- Department of Ophthalmology, Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
| | - Ramin Tadayoni
- Department of Ophthalmology, Hôpital Fondation Adolphe De Rothschild, Paris, France
- Department of Ophthalmology, Université Paris Cité, AP-HP, Hôpital Lariboisière, Paris, France
| |
Collapse
|
8
|
Kim DJ, Kim DG, Park KH. THREE-DIMENSIONAL HEADS-UP VITRECTOMY VERSUS CONVENTIONAL MICROSCOPIC VITRECTOMY FOR PATIENTS WITH EPIRETINAL MEMBRANE. Retina 2023; 43:1010-1018. [PMID: 36763981 DOI: 10.1097/iae.0000000000003762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
PURPOSE To investigate the efficacy and safety of 3D heads-up display (3D-HUD) vitrectomy compared with conventional microscopy (CM) vitrectomy in epiretinal membrane (ERM) surgery. METHODS Epiretinal membrane removal with or without internal limiting membrane (ILM) peeling was performed using a 3D-HUD or CM system. The mean changes in best-corrected visual acuity (BCVA) and in central macular thickness (CMT) and postoperative complications were assessed. RESULTS Baseline demographics were comparable except for the follow-up period. Both BCVA and CMT improved at the final visit (all P < 0.05). The ERM recurrence and dissociated optic nerve fiber layer (DONFL) rates were lower in the 3D group (both P < 0.05). conventional microscopic vitrectomy (odds ratio [OR] = 12.86, P = 0.02) and absence of ILM peeling (OR = 45.25, P < 0.05) were associated with ERM recurrence. In the DONFL, CM vitrectomy (OR = 1.98, <0.05) and combined phacovitrectomy (OR = 2.33, P = 0.03) were analyzed as risk factors for DONFL. CONCLUSION The improvement in BCVA and CMT in ERM surgery using a 3D-HUD is comparable with that of CM vitrectomy, with a significantly low rate of ERM recurrence and DONFL occurrence. Therefore, 3D vitrectomy might have an advantage for ERM surgery.
Collapse
Affiliation(s)
- Dong Ju Kim
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong Geun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; and
| | - Kyu Hyung Park
- Department of Ophthalmology, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea; and
| |
Collapse
|
9
|
Giansanti F, Nicolosi C, Bacherini D, Soloperto F, Sarati F, Giattini D, Vicini G. Three-Dimensional Visualization System for Vitreoretinal Surgery: Results from a Monocentric Experience and Comparison with Conventional Surgery. Life (Basel) 2023; 13:1289. [PMID: 37374072 DOI: 10.3390/life13061289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE To describe the experience of our centre (Careggi University Hospital, Florence, Italy) in using a heads-up three-dimensional (3D) surgical viewing system in vitreoretinal surgery, making a comparison with the conventional microscope surgery. METHODS We retrospectively analyzed data taken from 240 patients (240 eyes) with surgical macular diseases (macular hole and epiretinal membrane), retinal detachment or vitreous hemorrhage who underwent vitreoretinal surgeries, by means of the NGENUITY 3D Visualization System (Alcon Laboratories Inc., Fort Worth, TX, USA), in comparison with 210 patients (210 eyes) who underwent vitreoretinal surgeries performed using a conventional microscope. All surgeries were performed with standardized procedures by the same surgeons. We analyzed data over a follow-up period of 6 months, comparing the surgical outcomes (best-corrected visual acuity, anatomical success rate and postoperative complication rate) between the two groups. RESULTS the 3D group included 74 patients with retinal detachment, 78 with epiretinal membrane, 64 with macular hole and 24 with vitreous hemorrhage. There were no significant differences in the demographic and clinical characteristics between the 3D group and the conventional group. We found no significant differences in outcome measures at three and six months follow-up between the two groups (p-value ≥ 0.05 for all comparisons). Surgery durations were similar between the two groups. CONCLUSIONS In our experience, a heads-up 3D surgical viewing system provided comparable functional and anatomical outcomes in comparison with conventional microscope surgery, proving to be a valuable tool for vitreoretinal surgery in the treatment of different retinal diseases.
Collapse
Affiliation(s)
- Fabrizio Giansanti
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Cristina Nicolosi
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Daniela Bacherini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Federica Soloperto
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Federica Sarati
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Dario Giattini
- Eye Clinic, Neuromuscular and Sense Organs Department, Careggi University Hospital, 50134 Florence, Italy
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
| | - Giulio Vicini
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, 50121 Florence, Italy
- Azienda USL Toscana Nord Ovest, 56121 Pisa, Italy
| |
Collapse
|
10
|
Savastano A, Ripa M, Savastano MC, De Vico U, Caporossi T, Kilian R, Rizzo S. Comparison of novel digital microscope using integrated intraoperative OCT with Ngenuity 3D visualization system in phacoemulsification. CANADIAN JOURNAL OF OPHTHALMOLOGY 2023; 58:162-167. [PMID: 34562380 DOI: 10.1016/j.jcjo.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/18/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To compare surgical efficiency, visual and physical comfort, and safety profile of the ARTEVO 800 Digital Microscope (Carl Zeiss Meditec AG, Jena, Germany) and the Ngenuity 3D Visualization System (Alcon Laboratories Inc, Fort Worth, TX) in cataract surgery. DESIGN Cross-sectional study. PARTICIPANTS One hundred consecutive phacoemulsification cataract surgeries performed by five surgeons from June 1, 2020, to November 1, 2020. METHODS For each case, the surgeons answered a 2-section questionnaire (before and after intervention) to collect data on cataract severity or grade, surgical risk, chosen three-dimensional (3D) visualization system, surgical complications, and the visual or physical discomfort experienced during the procedure. RESULTS Each of the 5 surgeons performed 20 surgeries (N = 100) using either the ARTEVO 800 Digital Microscope (N = 50) or the Ngenuity Visualization System (N = 50). Mean duration of the surgical procedure was 17.07 ± 4.80 minutes, and none of the surgeons ever switched to the classical microscope. In addition, 40% of surgeries were considered at low risk, 30% at intermediate risk, and 30% at high risk. The Zoom, Focus, and XY commands were used 1-3 times, respectively, during 76 (p = 0.34), 73 (p = 0.49), and 76 (p = 0.64) interventions. Surgical uncertainty and operative fluency were similar using both systems (p = 0.53 and p = 0.19). We observed 14 intraoperative complications, 9 using Ngenuity and 5 using the ARTEVO 800. Surgeon's visual comfort (p = 0.79), colour or brightness perception (p = 0.82), and visual impairment (p = 0.62) during surgery were similar for both systems. Headache, backache, and other musculoskeletal problems were reported, respectively, after 14 (p = 0.79), 11 (p = 0.99), and 8 (p = 0.44) procedures. CONCLUSION Both the Ngenuity 3D Visualization System (Alcon Laboratories Inc) and the ARTEVO 800 Digital Microscope (Carl Zeiss Meditec AG) provided comparable operative speed and overall surgical comfort during cataract surgery.
Collapse
Affiliation(s)
- Alfonso Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University "Sacro Cuore," Rome, Italy.
| | - Matteo Ripa
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University "Sacro Cuore," Rome, Italy
| | - Maria Cristina Savastano
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University "Sacro Cuore," Rome, Italy
| | - Umberto De Vico
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Tomaso Caporossi
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University "Sacro Cuore," Rome, Italy
| | | | - Stanislao Rizzo
- Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy; Catholic University "Sacro Cuore," Rome, Italy; Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Pisa, Italy
| |
Collapse
|
11
|
Zhao XY, Zhao Q, Li NN, Meng LH, Zhang WF, Wang EQ, Chen YX. Surgery-related characteristics, efficacy, safety and surgical team satisfaction of three-dimensional heads-up system versus traditional microscopic equipment for various vitreoretinal diseases. Graefes Arch Clin Exp Ophthalmol 2023; 261:669-679. [PMID: 36210375 PMCID: PMC9988774 DOI: 10.1007/s00417-022-05850-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 09/01/2022] [Accepted: 09/22/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To compare the three-dimensional (3D) heads-up surgery with the traditional microscopic (TM) surgery for various vitreoretinal diseases. METHODS A medical record review of patients that underwent 3D heads-up or TM vitreoretinal surgeries was performed from May 2020 to October 2021 in this retrospective case-control study. Main outcome measures included surgery-related characteristics, efficacy, safety, and satisfaction feedback from the surgical team. RESULTS A total of 220 (47.6%) and 242 (52.4%) eyes were included in the 3D and TM groups, respectively. The 3D heads-up system significantly benefits delicate surgical steps, like the epiretinal membrane (ERM) peeling for ERM and internal limiting membrane peeling for idiopathic macular holes (P < 0.05). The 3D heads-up system could facilitate a significantly better visual outcome for pathologic myopic foveoschisis (P = 0.049), while no difference by TM surgery (P = 0.45). For the satisfaction feedback, the 3D heads-up system was rated significantly higher in most subscales and the overall score (P < 0.05). The surgeons' ratings on operating accuracy and the first assistants' rating on operating accuracy and operation cooperation were significantly higher in the TM group than in the 3D group (P < 0.05). Besides that, the 3D heads-up surgery was comparable with TM surgery in the surgery-related characteristics, choice of tamponades, postoperative VA, primary anatomic success, and perioperative complications (P > 0.05). CONCLUSION The efficacy and safety of the 3D heads-up surgery were generally comparable to the TM surgery. The 3D heads-up system could significantly benefit delicate surgical steps and achieve better surgical team satisfaction.
Collapse
Affiliation(s)
- Xin-Yu Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Qing Zhao
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Ning-Ning Li
- Department of Operating Room, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Li-Hui Meng
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Wen-Fei Zhang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - Er-Qian Wang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China
| | - You-Xin Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China. .,Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
| |
Collapse
|
12
|
Zeng R, Feng Y, Begaj T, Baldwin G, Miller JB. Comparison of the Safety and Efficacy of a 3-Dimensional Heads-up Display vs a Standard Operating Microscope in Retinal Detachment Repair. JOURNAL OF VITREORETINAL DISEASES 2023; 7:97-102. [PMID: 37006657 PMCID: PMC10037757 DOI: 10.1177/24741264221150074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Purpose: To evaluate the safety, efficacy, and efficiency of the Ngenuity 3-dimensional (3D) heads-up display (HUD) visualization system for primary rhegmatogenous retinal detachment (RRD) repair at a large academic medical center in the United States. Methods: This retrospective review comprised consecutive patients aged 18 years or older who had primary RRD repair (pars plana vitrectomy [PPV] alone or combined PPV and scleral buckle) performed by the same fellowship-trained vitreoretinal surgeon using the 3D visualization system and a traditional standard operating microscope (SOM) at Massachusetts Eye and Ear from June 2017 to December 2021. The minimum follow-up was 90 days. Results: The 3D HUD group comprised 50 eyes of 47 patients and the SOM group, 138 eyes of 136 patients. There were no between-group differences in single surgery anatomic success rates at 3 months (98% HUD vs 99% SOM; P = 1.00) or at the last follow-up (94% HUD vs 98% SOM; P = .40). The rate of postoperative proliferative vitreoretinopathy was similar between the 2 groups (3 months: 3% HUD vs 5% SOM, P = .94; last follow-up, 2% HUD vs 3% SOM, P = .93). There was no difference in the mean duration of surgery (57.4 ± 28.9 minutes HUD vs 59.4 ± 29.9 minutes SOM; P = .68). Conclusions: Anatomic and functional outcomes, in addition to surgical efficiency, of noncomplex primary RRD repair with a 3D HUD system were similar to those of surgery performed with an SOM.
Collapse
Affiliation(s)
- Rebecca Zeng
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - Yilin Feng
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - Tedi Begaj
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - Grace Baldwin
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| | - John B. Miller
- Harvard Retinal Imaging Lab, Department
of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
- Retina Service, Department of
Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA,
USA
| |
Collapse
|
13
|
Nespolo RG, Yi D, Cole E, Wang D, Warren A, Leiderman YI. Feature Tracking and Segmentation in Real Time via Deep Learning in Vitreoretinal Surgery: A Platform for Artificial Intelligence-Mediated Surgical Guidance. Ophthalmol Retina 2023; 7:236-242. [PMID: 36241132 DOI: 10.1016/j.oret.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE This study investigated whether a deep-learning neural network can detect and segment surgical instrumentation and relevant tissue boundaries and landmarks within the retina using imaging acquired from a surgical microscope in real time, with the goal of providing image-guided vitreoretinal (VR) microsurgery. DESIGN Retrospective analysis via a prospective, single-center study. PARTICIPANTS One hundred and one patients undergoing VR surgery, inclusive of core vitrectomy, membrane peeling, and endolaser application, in a university-based ophthalmology department between July 1, 2020, and September 1, 2021. METHODS A dataset composed of 606 surgical image frames was annotated by 3 VR surgeons. Annotation consisted of identifying the location and area of the following features, when present in-frame: vitrector-, forceps-, and endolaser tooltips, optic disc, fovea, retinal tears, retinal detachment, fibrovascular proliferation, endolaser spots, area where endolaser was applied, and macular hole. An instance segmentation fully convolutional neural network (YOLACT++) was adapted and trained, and fivefold cross-validation was employed to generate metrics for accuracy. MAIN OUTCOME MEASURES Area under the precision-recall curve (AUPR) for the detection of elements tracked and segmented in the final test dataset; the frames per second (FPS) for the assessment of suitability for real-time performance of the model. RESULTS The platform detected and classified the vitrector tooltip with a mean AUPR of 0.972 ± 0.009. The segmentation of target tissues, such as the optic disc, fovea, and macular hole reached mean AUPR values of 0.928 ± 0.013, 0.844 ± 0.039, and 0.916 ± 0.021, respectively. The postprocessed image was rendered at a full high-definition resolution of 1920 × 1080 pixels at 38.77 ± 1.52 FPS when attached to a surgical visualization system, reaching up to 87.44 ± 3.8 FPS. CONCLUSIONS Neural Networks can localize, classify, and segment tissues and instruments during VR procedures in real time. We propose a framework for developing surgical guidance and assessment platform that may guide surgical decision-making and help in formulating tools for systematic analyses of VR surgery. Potential applications include collision avoidance to prevent unintended instrument-tissue interactions and the extraction of spatial localization and movement of surgical instruments for surgical data science research. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Rogerio Garcia Nespolo
- Department of Ophthalmology and Visual Sciences - Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois; Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois
| | - Darvin Yi
- Department of Ophthalmology and Visual Sciences - Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois; Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois
| | - Emily Cole
- Department of Ophthalmology and Visual Sciences - Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Daniel Wang
- Department of Ophthalmology and Visual Sciences - Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Alexis Warren
- Department of Ophthalmology and Visual Sciences - Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois
| | - Yannek I Leiderman
- Department of Ophthalmology and Visual Sciences - Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois; Richard and Loan Hill Department of Biomedical Engineering, University of Illinois at Chicago, Chicago, Illinois.
| |
Collapse
|
14
|
Effects of image-sharpening algorithm on surgical field visibility during 3D heads-up surgery for vitreoretinal diseases. Sci Rep 2023; 13:2758. [PMID: 36797311 PMCID: PMC9935873 DOI: 10.1038/s41598-023-29882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/11/2023] [Indexed: 02/18/2023] Open
Abstract
We conducted clinical and experimental studies to investigate the effects of image-sharpening algorithms and color adjustments, which enabled real-time processing of live surgical images with a delay of 0.004 s. The images were processed with image-sharpening intensities of 0%, 12.5%, 25%, and 50% during cataract surgery, vitrectomy, peeling of epiretinal membrane, and peeling of internal limiting membrane (ILM) with the Ngenuity 3D visualization system. In addition, the images obtained with a yellow filter during the ILM peeling were processed with color adjustments. Five vitreoretinal surgeons scored the clarity of the images on a 10-point scale. The images of a 1951 United States Air Force grating target placed in no fluid (control), saline, and 0.1% and 1% milk solution were evaluated. The results showed that the mean visibility score increased significantly from 5.0 ± 0.6 at 0% to 6.4 ± 0.6 at 12.5%, 7.3 ± 0.7 at 25%, and 7.5 ± 0.9 at 50% (P < 0.001). The visibility scores during ILM peeling improved significantly with color adjustments (P = 0.005). In the experimental study, the contrast of the grating targets blurred by the 0.1% and 1% milk solution increased significantly by the image-sharpening procedure. We conclude that the image-sharpening algorithms and color adjustments improved the intraoperative visibility of 3D heads-up surgery.
Collapse
|
15
|
Muecke TP, Casson RJ. Three-Dimensional Heads-up Display in Cataract Surgery: A Review. Asia Pac J Ophthalmol (Phila) 2022; 11:549-553. [PMID: 36417680 DOI: 10.1097/apo.0000000000000562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Intraocular visualization in cataract surgery is currently achieved using the ophthalmic surgical microscope (OSM). Three-dimensional (3D) heads-up display is a burgeoning intraocular visualization technique for cataract surgery, which projects the surgical view to a 3D monitor. A number of theoretical advantages of this system over the OSM have been proposed. 3D visualization is reported to provide improved depth perception and the heads-up display promotes a more ergonomic surgical position while providing an enhanced view for the entire surgical team. The modern OSMs, however, already allow for safe and efficient cataract surgery, and 3D heads-up display visualization is limited by a steep learning curve. We critically review the literature around 3D heads-up display cataract surgery and compare its safety profile to traditional visualization techniques.
Collapse
Affiliation(s)
- Thomas P Muecke
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Ophthalmology & Visual Science, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia
| | - Robert J Casson
- Ophthalmology Department, Royal Adelaide Hospital, Adelaide, SA, Australia
- Discipline of Ophthalmology & Visual Science, University of Adelaide, Adelaide Health and Medical Sciences Building, Adelaide, SA, Australia
| |
Collapse
|
16
|
Borroni D, Rocha-de-Lossada C, Bonci P, Rechichi M, Rodríguez-Calvo-de-Mora M, Rachwani-Anil R, Sánchez González JM, Urbinati F, Lorente MG, Vigo L, Carones F. Glasses-Assisted 3D Display System-Guided Descemet Membrane Endothelial Keratoplasty Tissue Preparation. Cornea 2022; 41:1444-1446. [PMID: 35184124 DOI: 10.1097/ico.0000000000003005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/04/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim of this study was to evaluate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) tissue preparation using a glasses-assisted 3-dimensional (3D) display system and to compare it with a conventional surgical microscope. METHODS Healthy pairs of human corneas suitable for penetrating keratoplasty surgery were selected for this study. The tissues were randomly divided into 2 groups. Each pair of corneas had 1 cornea (group 1) prepared with NGENUITY (Alcon) with a 5-second staining time with vision blue, and the fellow cornea (group 2) was prepared using a OPMI Lumera 700 surgical microscope (Carl Zeiss Meditec, Jena, Germany) with a 30-second staining time. DMEK graft preparation time, speed of stripping, graft width, and endothelial cell loss were evaluated. RESULTS Twenty-eight pairs of corneas were included in this study. The graft preparation time was significantly higher in the 3D group than in the conventional group (498 ± 147 vs. 418 ± 85 seconds, P value = 0.031). The mean speed of stripping was 0.59 ± 0.081 mm/s in group 1 and 0.089 ± 0.005 mm/s in group 2 ( P value = 0.024). The mean endothelial cell density in group 1 and group 2 before tissue preparation was 2162 ± 115.21 and 2153 ± 122.45, respectively ( P value > 0.1). After tissue preparation, the endothelial cell density reduced to 1911 ± 150.72 in group 1 and 1998 ± 90.72 in group 2 ( P value = P value > 0.05). The graft width was 5.05 ± 0.71 mm in group 1 and 4.92 ± 0.23 mm in group 2 ( P value > 0.05). CONCLUSIONS DMEK tissue preparation with 3D display system NGENUITY is feasible with a slightly increased preparation time. The improved visualization allows a reduced staining time that could be beneficial for eye banks because it may reduce the toxic effect of staining colorants.
Collapse
Affiliation(s)
- Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
- Advalia Vision, Cornea Research Unit, Milan, Italy
| | - Carlos Rocha-de-Lossada
- Department of Ophthalmology, Qvision (Vithas Almeria)
- University Hospital Virgen de Las Nieves, Granada, Spain
- Department of Ophthalmology, Ceuta Medical Center, Ceuta, Spain
| | - Paola Bonci
- Ospedale Civile di Ravenna, Banca Delle Cornee Della Regione Emilia-Romagna
| | | | | | | | | | | | | | - Luca Vigo
- Advalia Vision, Cornea Research Unit, Milan, Italy
| | | |
Collapse
|
17
|
A Review of Recent Advances in Vitreoretinal Surgical Visualization and Tissue Manipulation. CURRENT SURGERY REPORTS 2022. [DOI: 10.1007/s40137-022-00327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
18
|
Comparison of Three-Dimensional Surgical System Versus Binocular Microscope for Clear Corneal Incision in Cataract Surgery. Ophthalmol Ther 2022; 11:1589-1600. [PMID: 35749016 PMCID: PMC9244034 DOI: 10.1007/s40123-022-00537-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/31/2022] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION To compare surgical outcomes of 2.2 mm clear corneal incision (CCI) between a three-dimensional (3D) visualization system and traditional binocular microscope (BM) for phacoemulsification and intraocular lens implantation surgery. METHODS In this randomized controlled clinical study, 60 eyes with age-related cataracts were divided into two groups receiving cataract surgery using either a 3D vision system (n = 30 eyes) (3D group) or a binocular microscope (n = 30 eyes) (BM group). We recorded and statistically analyzed surgical parameters and pre- and postoperative ocular parameters. Primary outcomes included the change in endothelial cell density (ECD) and CCI architecture, and secondary outcomes comprised other ocular parameters and surgical parameters. All procedures complied with the tenets of the Declaration of Helsinki. RESULTS Of the 60 eyes randomly assigned between January 5, 2021, and May 9, 2021, 55 (26 eyes in the 3D group and 29 eyes in the BM group) were analyzed. The ECD loss rate was 8.1% in the 3D group and 12.3% in the BM group, but the difference was not statistically significant. Local detachment of Descemet's membrane was seen in 50% (13 eyes, 3D group) and 51.6% (15 eyes, BM group), wound gaping at the endothelial side in 15.4% (four eyes, 3D group) and 10.3% (four eyes, BM group), gaping at the epithelial side in 11.5% (three eyes, 3D group) and 6.9% (two eyes, BM group), and misalignment of the incision in 3.4% (one eye, BM group) 1 day after surgery. These abnormalities improved with time. There was no difference between the 3D group and BM group in terms of other ocular parameters or surgical parameters before and after surgery. CONCLUSIONS Using the 3D surgical system for phacoemulsification and IOL implantation surgery seems to result in similar ECD and CCI conditions as using a conventional binocular microscope. TRIAL REGISTRATION The protocol was registered on ClinicalTrials.gov (NCT04839250).
Collapse
|
19
|
Vitrectomy Combined with Cataract Surgery for Retinal Detachment Using a Three-Dimensional Viewing System. J Clin Med 2022; 11:jcm11071788. [PMID: 35407397 PMCID: PMC8999361 DOI: 10.3390/jcm11071788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/14/2022] [Accepted: 03/22/2022] [Indexed: 01/27/2023] Open
Abstract
Purpose: To evaluate the results of a pars plana vitrectomy (PPV) combined with cataract surgery for primary rhematogenous retinal detachment (RD) using a three-dimensional (3D) viewing system and a conventional microscope (CM). Methods: Medical reports of 82 patients were retrospectively reviewed: 26 patients were operated on with 3D and 56 patients were operated on with CM. The main outcome measures were visual acuity, duration of the surgery, and the rate of postoperative complications. Results: No statistically significant differences in pre- and postoperative visual acuity were found between both groups. There was significant improvement in the visual acuity in both groups. The best postoperative visual acuity was achieved with SF6 gas tamponade, followed by C3F8 gas and silicone oil in both groups. The duration of the surgery (60 min vs. 55 min) and the rate of postoperative complications (15% vs. 14%) were similar in both groups. Conclusions: The similar postoperative visual acuity and rate of complications detected using 3D and CM indicate that the 3D viewing system may be advantageous in the treatment of rhematogenous RD with PPV combined with cataract surgery, i.e., a complex procedure involving both anterior and posterior segment manipulations.
Collapse
|
20
|
|
21
|
Madanagopalan VG. Heads-up surgery in ophthalmology. TNOA JOURNAL OF OPHTHALMIC SCIENCE AND RESEARCH 2021. [DOI: 10.4103/tjosr.tjosr_179_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|