Background: 3D heads-up visualization systems are aimed to improve the surgical experience by providing high-resolution imaging. Objective of our study is to analyze, over a long-time span, the grade of satisfaction and safety of day-to-day 3D surgery compared to standard surgery and to investigate the technical distinctiveness between the heads-up systems currently in use. Methods: In this retrospective observational case series. we reviewed all surgical records of our ophthalmology-dedicated operatory rooms since the arrival of 3D heads-up viewing system, in November 2017. In particular, we compared the procedural complications of 3D-equipped operatory room (3DR) with the standard microscope operatory room (2DR). Moreover, a satisfaction questionnaire was administered to those surgeons shifting on both rooms to test their preferences on seven specific parameters (comfort, visibility, image quality, depth perception, simplicity of use, maneuverability and teaching potential). Results: 5483 eye surgeries were considered. 2777 (50.6%) were performed in 3DR and 2706 (49.3%) in 2DR. Procedural complication rate was comparable in 3DR and 2DR, also when considering different subtypes of surgery. Twelve surgeons (100% of our surgery team) participated in our satisfaction survey, expressing highest satisfaction score for 3D when applied in retina surgery. For cataract surgery, 3D scored best in all the parameters except for facility in use and depth of field perception. Conclusion: Long-term day-to-day use of 3D heads-up visualization systems showed its safety and its outstanding teaching potential in all ophthalmic surgical subtypes, with higher surgeons confidence for retina and cataract surgery.

Patients with Alzheimer's disease (AD) reportedly exhibit greater pupillary dilation than healthy subjects in response to tropicamide. By means of videopupillography, we have found that the average basal pupillary diameter was greater in AD patients than in normal controls and that there is an inverse relationship between the average pupillary diameter and the maximal dilation obtained following tropicamide application in both groups. Pupillary response to tropicamide and videopupillography do not distinguish between Alzheimer's patients and controls.

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Introduction: Scleral buckling (SB) has been the first technique to repair a retinal detachment (RD) and it is still largely in use. Pars plana vitrectomy (PPV) is currently the most common technique, being more versatile and easier to approach. Here we report on a new SB variant, modified by using some of the latest technological advances borrowed from PPV. Methods: We retrospectively reviewed all our SB cases from November 2017 to November 2018, all of them performed with a chandelier, mounted on valved trocar, to provide 3D wide-angle viewing. 107 eyes of 107 patients (mean age of 59 ± 8 years, 61 [57%] males) underwent primary uncomplicated RD surgery using this modified SB technique and were enrolled for this study. Results: In this article, the technique is thoroughly described with an online video presentation. Briefly, thanks to valved trocar insertion, it combines the latest breakthroughs in the field of PPV viewing systems with traditional SB surgery. Our first-year data reveal a primary success rate of 94% (101 cases out of 107) at 3 months follow-up. A hidden retinal lesion, undetected at clinical pre-operative evaluation, was found intraoperatively in 12 (8.9%) cases. Conclusion: The use of a digital three-dimensional (3D) visualization system, coupled with the positioning of a single 25 gauge valved trocar with chandelier, dramatically simplifies the traditional SB and flattens its learning curve, making this procedure more accessible to young surgeons. In addition, the better visualization capability yields to higher possibility to detect and treat all retinal lesions.

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