Efficacy of 3D digital visualization in minimizing coaxial illumination and phototoxic potential in cataract surgery: pilot study

Abstract

Purpose: To compare the coaxial light intensity required during cataract surgery and rate of postoperative visual recovery, with surgical visualization achieved with a traditional analog operating microscope compared with a 3D digital visualization system. Setting: Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York. Design: Retrospective, consecutive, single-surgeon series. Methods: Patients undergoing femtosecond laser–assisted cataract surgery were retrospectively grouped into either: (1) visualization using the binoculars of a standard operating microscope (traditional group) or (2) visualization using a 3D digital visualization system affixed to the same operating microscope (digital group). Note was made in each case of light intensity used, light exposure time, intraoperative and/or postoperative complications, and postoperative visual acuities. Results: The study comprised 24 eyes in the traditional group and 27 eyes in the digital group. There were no intraoperative or postoperative complications in either group and no difference in mean light exposure time, but the mean light intensity used in the digital group was significantly less (18.5% ± 1.5%) than that in the traditional group (43.3% ± 3.7%; P < .001). Furthermore, the digital group achieved a postoperative day 1 visual acuity that was within 2 lines of the postoperative month 1 visual acuity a greater percentage of time than that in the traditional group (81.5% of eyes vs 54.2% of eyes; P = .04). Conclusions: Light intensity was significantly decreased in patients who underwent cataract surgery assisted by the 3D digital visualization platform without an increase in complications or surgical time and possibly with a faster postoperative visual recovery.

Three-Dimensional Heads-Up vs. Standard Operating Microscope for Cataract Surgery: A Systematic Review and Meta-Analysis

“…Finally, a total of 11 studies of 11 articles (8842 eyes) met the inclusion and exclusion criteria and were included in the systematic review and meta-analysis. Notably, nine studies were included in the meta-analysis of postoperative BCVA [ 4 , 5 , 6 , 8 , 9 , 10 , 11 , 12 , 14 ] and mean surgical time duration [ 4 , 5 , 7 , 8 , 9 , 11 , 12 , 13 , 14 ], and only five studies were included in the meta-analysis of the incidence rate of intraoperative complications [ 5 , 7 , 9 , 13 , 14 ].…”

“…A summary of the main characteristics including the first author, year published, study design, 3D HUVS used, SOM used, number of cataract surgeries, mean surgical time duration, the incidence rate of intraoperative complications, postoperative BCVA, mean light exposure time/ocular surface illuminance, and other parameters evaluated are summarized in Table 1 . We assessed three RCTs [ 5 , 7 , 13 ], two non-RCT [ 9 , 14 ], and six comparative observational studies [ 4 , 6 , 8 , 10 , 11 , 12 ]. The participants ranged from 20 to 3286, with 4816 receiving 3D HUVS cataract surgery and 4026 receiving SOM cataract surgery.…”

“…Among the studies, three studies [ 10 , 11 , 13 ] compared the 3D heads-up visualization system and standard operating microscope in different routine ophthalmologic procedures. In contrast, the other eight studies only reported data related to cataract surgery [ 4 , 5 , 6 , 7 , 8 , 9 , 12 , 14 ]. Seven studies used the Ngenuity 3D visualization system [ 4 , 6 , 7 , 8 , 11 , 12 , 13 ], whereas the Artevo 800 and the NCVideo 3D system were used in only three studies [ 5 , 9 , 14 ].…”

“…The 3D HUVS offers better ergonomics (the surgeon does not need to bend the neck to look into the microscope eyepieces) and better visualization (high-resolution surgical field visualization with better magnification). Furthermore, 3D imaging is beneficial for teaching, as everyone in the operating room can see the same high-resolution view that the surgeon observes on the screen [ 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 ]. However, some studies reported different 3D HUVS drawbacks, such as a possible longer surgical time, a challenging learning curve, and a higher surgical workload [ 9 , 11 ].…”

Use of Black-and-White Digital Filters to Optimize Visualization in Cataract Surgery

“…A three-dimensional (3D) heads-up system was recently introduced for both vitreoretinal and cataract surgery, radically improving the quality of surgical visualization. This system has several advantages over conventional microscopes, including digitally enhanced imaging, which provides high-quality visualization, with lower levels of illumination during surgery, increasing patient comfort [ 3 , 4 ]. The 3D system extends the depth of field, thereby improving visualization of the anterior chamber at high magnification.…”