In the JournalsPerspective

Heads-up 3-D visualization system offers similar safety, efficacy as traditional microscope

A heads-up 3-D visualization system had similar complication rates and duration of surgery as a traditional binocular microscope for cataract surgery, according to a study.

“The study demonstrated that heads-up cataract surgery through a 3-D visualization display has similar safety and efficiency to the gold standard surgical microscope. Using this visualization approach, surgeons maintain a more flexible body posture (without the need for the surgeon to rotate his/her neck or torso), making surgery more comfortable and avoiding occupational-related injuries,” study co-author Vasilios F. Diakonis, MD, PhD, told Healio.com/OSN.

A retrospective case series included 2,320 eyes that underwent cataract surgery, with 1,673 eyes undergoing surgery with the Ngenuity 3D visualization system (Alcon) and 647 eyes undergoing surgery with a traditional binocular microscope. Patients underwent either femtosecond laser-assisted cataract surgery or traditional phacoemulsification. Complication rates and duration of surgery were evaluated.

Mean surgical time for the 3-D group was 6.48 ± 1.15 minutes compared with 6.52 ± 1.38 minutes in the traditional microscope group. The difference was not statistically significant.

The 3-D cohort had 12 complications compared with five complications in the traditional group, which was not a statistically significant difference. Both groups reported posterior capsular rupture, vitreous prolapse with need for anterior vitrectomy and three-piece sulcus IOL implantation as complications. – by Robert Linnehan

Disclosures: Diakonis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

A heads-up 3-D visualization system had similar complication rates and duration of surgery as a traditional binocular microscope for cataract surgery, according to a study.

“The study demonstrated that heads-up cataract surgery through a 3-D visualization display has similar safety and efficiency to the gold standard surgical microscope. Using this visualization approach, surgeons maintain a more flexible body posture (without the need for the surgeon to rotate his/her neck or torso), making surgery more comfortable and avoiding occupational-related injuries,” study co-author Vasilios F. Diakonis, MD, PhD, told Healio.com/OSN.

A retrospective case series included 2,320 eyes that underwent cataract surgery, with 1,673 eyes undergoing surgery with the Ngenuity 3D visualization system (Alcon) and 647 eyes undergoing surgery with a traditional binocular microscope. Patients underwent either femtosecond laser-assisted cataract surgery or traditional phacoemulsification. Complication rates and duration of surgery were evaluated.

Mean surgical time for the 3-D group was 6.48 ± 1.15 minutes compared with 6.52 ± 1.38 minutes in the traditional microscope group. The difference was not statistically significant.

The 3-D cohort had 12 complications compared with five complications in the traditional group, which was not a statistically significant difference. Both groups reported posterior capsular rupture, vitreous prolapse with need for anterior vitrectomy and three-piece sulcus IOL implantation as complications. – by Robert Linnehan

Disclosures: Diakonis reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

    Perspective
    Sumit Garg

    Sumit Garg

    Surgical positioning and ergonomics are daily struggles for surgeons. All too often surgeons stretch, extend and contort to get through surgical cases. While this is easier when we are younger, the more cases we do and the older we get, the harder this becomes. While there have been many innovations with respect to surgical guidance and intraoperative tools, the mainstay of our intraoperative imaging remains the surgical microscope with oculars. About a decade ago, we saw our first innovations with respect to heads-up 3-D intraoperative visualization. Early iterations of this technology required a microscope-mounted camera that had a noticeable delay, loss of illumination from the beam splitter and dependence on a large computer console in the operating room.

    Heads-up 3-D intraoperative imaging has come a long way from its inception. With Alcon’s launch of its Ngenuity system, we now have a heads-up system that incorporates a 4K OLED monitor with no noticeable delay. The system has gained popularity for both anterior and posterior segment surgery. The big question with respect to heads-up imaging systems is whether they are as safe and efficient as traditional microscope viewing.

    Weinstock and colleagues present their retrospective study comparing safety (posterior capsular tear and vitrectomy rates) and efficiency (surgical time) between traditional visualization and 3-D heads-up visualization. The study showed statistical equivalence in both the measured safety and efficiency parameters. As with any study, there were drawbacks. Namely, the study excluded cases that could be considered complex (for example, pseudoexfoliation, Fuchs’ endothelial dystrophy or prior surgery), toric IOL cases, as well as those that included ancillary testing (intraoperative aberrometry). Additionally, this was a single-surgeon case series. Despite these limitations, the study results are promising.

    At this year’s American Society of Cataract and Refractive Surgery meeting, Zeiss launched its own version of a 3-D heads-up imaging system that integrates intraoperative OCT, guidance and other enhancements to traditional viewing. With more and more of these types of systems on the horizon, we are looking at a shift in how will be approaching surgical visualization in years to come. Studies like the one presented here are helpful in changing the status quo, and I look forward to continued innovations in this space.

    • Sumit Garg, MD
    • OSN Cataract Surgery Board Member

    Disclosures: Garg reports no relevant financial disclosures.