Comparison of a Three-Dimensional Heads-Up Display Surgical Platform with a Standard Operating Microscope for Macular Surgery

Comparing Heads-Up versus Binocular Microscope Visualization Systems in Anterior and Posterior Segment Surgeries: A Retrospective Study

“…Reducing the intensity of endoillumination and of the visible light use at the expense of infrared wavelengths in order to reduce light-induced retinal damages could be a major potential benefit of heads-up systems [3-5, 10, 11]. However, the intensity of endoillumination for vitreoretinal procedures did not differ in this study with the type of visualization, contrary to other studies (up to 60-80% decrease in endoillumination intensity described by Eckardt et al [5], 17% decrease reported by Talcott et al [9], or a 10% intensity used by Adam et al [4] or Zhang et al [3]). The mean percentages used in our study were equivalent to those found in the literature for standard BM procedures (around 30%).…”

“…Of note, 3 surgeries out of 107 were not analysed because of "too low visual comfort" with 3D, leading to a switch to the BM system. Rizzo et al [6] made a similar observation, whereas in macular surgeries Talcott et al [9] reported an ease of use significantly higher with BM. Surgeons not used to wearing glasses felt uncomfortable with 3D glasses throughout the trial, and most of them experienced headaches during the first 10-15 procedures.…”

“…This technique for increasing the depth of field is not as intuitive as in BM and takes time, even after a 4-week training period; this could explain the lack of difference in the duration of PPV surgeries between 3D and BM, contrary to that observed in PK surgeries. Talcott et al [9] found increased macular peel times using the 3D, although overall surgical times were similar with BM, in macular surgeries. Other studies have observed differences in the duration of PPV surgeries between 3D and BM [3,7], and we also noticed a trend of 3D procedures being longer (Table 3), as did Romano et al [7].…”

“…There were two serious complications in the BM group (zonular dialysis and posterior capsular rent with sulcus implantation) and one in the 3D group (lens touch) out of the 9 complications reported among all procedures. Among other studies assessing intraoperative complications, one lens touch in a 25-G 3D-assisted vitreoretinal procedure [7] or no complications in a 3D-assisted surgery cohort of 31 eyes [3],10 eyes [4], or 23 eyes [9] was reported.…”

Vitreoretinal surgery tip and tricks in the era of COVID-19

“…Three-dimensional (3D) heads-up display surgical visualization is an evolving technology demonstrating comparable efficacy to the standard operating microscope for macular surgery [8]. The use of 3D heads-up display systems in the COVID era can help in increasing the distance between surgeon and patient and also in improving ergonomics (Fig.…”