Comparison of clinical outcomes between “heads-up” 3D viewing system and conventional microscope in macular hole surgeries: A pilot study

Abstract

Purpose:To compare clinical outcomes of patients undergoing macular hole surgery with heads-up three-dimensional (3D) viewing system and conventional microscope.Methods:In all, 50 eyes of 50 patients with stage 3 or 4 macular hole were randomized and macular hole surgery [inverted internal limiting membrane (ILM) flap technique] was performed in 25 eyes using 3D viewing system and 25 eyes using conventional microscope. All surgeries were performed by a single surgeon. Patients were followed up for a period of 3 months. Logarithm of the minimum angle of resolution (logMAR) visual acuity, macular hole index, intraoperative parameters such as total surgical time, total ILM peel time, number of flap initiations, duration of Brilliant Blue G dye exposure, illumination intensity, postoperative logMAR visual acuity, and macular hole closure rates were recorded and compared between the two groups.Results:The mean age was 67.92 ± 7.95 and 67.96 ± 4.78 years in both groups, respectively (P = 0.98). Gender (P = 0.38) and right versus left eye (P = 0.39) were also comparable. Preoperative and postoperative best-corrected visual acuity (P = 0.86, 0.92), macular hole index (P = 0.96), total surgical time (P = 0.56), total ILM peel time (P = 0.49), number of flap initiations (P = 0.11), and macular hole closure rates (P = 0.61) were not statistically significant when compared between the two groups. Illumination intensity of microscope (100% vs 45%) and endoillumination (40% vs 13%) were significantly less in the 3D viewing system.Conclusion:The clinical outcomes of macular hole surgery using 3D viewing system are not inferior to that of conventional microscopes, and it has the added advantages of better ergonomics, reduced phototoxicity, peripheral visualization, magnification, and less asthenopia, and it serves as a good educational tool.

Heads-up 3D viewing system in rhegmatogenous retinal detachment with proliferative vitreoretinopathy - A prospective randomized trial

“…In our study, mean surgical duration with 3D DAVS was comparable to CAM. This result is supported by works of Coppola et al in 2017, Romano et al in 2018, Kumar et al in 2018, Palacois et al in 2019, Babu et al in 2020 and Berquet et al [ 4 10 11 13 17 22 ] Few studies have reported longer surgical duration but this can be attributed to learning curve of the surgeon. [ 12 ]…”

“…Various studies have been done in the past to assess the feasibility of performing vitreoretinal surgeries on 3D DAVS and have reported excellent outcomes, minimal complications, comparable surgical duration, and lower endoillumination. [ 10 11 12 13 14 15 16 17 18 19 20 21 22 ]…”

Heads-Up 3D Surgery under Low Light Intensity Conditions: New High-Sensitivity HD Camera for Ophthalmological Microscopes

“…Retinal phototoxicity is a rare but proven risk of ocular surgery [5, 6]. Digital image enhancements help reduce the illumination to a considerable degree, decreasing the phototoxicity to the retinal pigmented epithelium cells and photoreceptors [8].…”

Comparison of Simulated Surgical Skills Using Different Camera Aperture Settings for Digitally Assisted Vitreoretinal Surgery

“…On the other hand, Kumar and colleagues also compared surgical time on a DAVS and a conventional microscope, and again no statistical difference was reached and the DAVS procedures took longer. 6 This time, the aperture employed was not mentioned but the TV-viewing distance was 2 m (6.6 ft), which reduces LR and DOF, making DAVS surgeries take longer. To our knowledge, this is the first study that compares different camera aperture settings in a DAVS evaluating surgical skills and time, which seem to be important because of the lack of unification for this parameter.…”