Surgery-related characteristics, efficacy, safety and surgical team satisfaction of three-dimensional heads-up system versus traditional microscopic equipment for various vitreoretinal diseases

Abstract

Purpose To compare the three-dimensional (3D) heads-up surgery with the traditional microscopic (TM) surgery for various vitreoretinal diseases. Methods A medical record review of patients that underwent 3D heads-up or TM vitreoretinal surgeries was performed from May 2020 to October 2021 in this retrospective case–control study. Main outcome measures included surgery-related characteristics, efficacy, safety, and satisfaction feedback from the surgical team. Results A total of 220 (47.6%) and 242 (52.4%) eyes were included in the 3D and TM groups, respectively. The 3D heads-up system significantly benefits delicate surgical steps, like the epiretinal membrane (ERM) peeling for ERM and internal limiting membrane peeling for idiopathic macular holes (P < 0.05). The 3D heads-up system could facilitate a significantly better visual outcome for pathologic myopic foveoschisis (P = 0.049), while no difference by TM surgery (P = 0.45). For the satisfaction feedback, the 3D heads-up system was rated significantly higher in most subscales and the overall score (P < 0.05). The surgeons’ ratings on operating accuracy and the first assistants’ rating on operating accuracy and operation cooperation were significantly higher in the TM group than in the 3D group (P < 0.05). Besides that, the 3D heads-up surgery was comparable with TM surgery in the surgery-related characteristics, choice of tamponades, postoperative VA, primary anatomic success, and perioperative complications (P > 0.05). Conclusion The efficacy and safety of the 3D heads-up surgery were generally comparable to the TM surgery. The 3D heads-up system could significantly benefit delicate surgical steps and achieve better surgical team satisfaction.

Objective Quantification of Depth-of-Field Advantage in 3D Surgical Video System for Vitreoretinal Surgery: Safety and Efficacy in Macular Diseases

“…16 Based on previous research and analysis, 3D surgical video systems have superior visualization capabilities, which can improve the efficiency of membrane peeling in vitrectomy and reduce the incidence of intraoperative complications, especially in complex and long-duration vitreoretinal surgeries. 17 The advantages of 3D surgical video systems in macular surgeries include reduced intraocular illumination and minimized phototoxicity to retinal cells. 18 In addition, the filter function combined with the 3D surgical video system can lower the dye concentration or reduce the dyeing time, thereby reducing possible adverse reactions to the dyes.…”

Three-dimensional heads-up system assisted pars plana vitrectomy and subretinal recombinant tissue plasminogen activator injection for submacular hemorrhage

“…The 3D surgical system has been reported to have multiple advantages including a wider visual field and higher magnification performance compared with the TM system [ 12 , 13 ]. Our previous study further indicated that the 3D heads-up system was associated with a significantly shorter duration of delicate surgical steps, like ILM peeling, than the TM system [ 14 ]. Besides, previous studies also reported the occurrence of iatrogenic circumscribed semicircular rip in the RPE and macular hole caused by the inadvertent injection of the rt-PA [ 31 , 34 , 35 ], which may be avoided using the 3D heads-up system with a higher magnification.…”

“…In 2016, Eckardt et al [8] applied the three-dimensional (3D) heads-up system in complicated posterior segment surgeries, sparking ophthalmologists' interest in using this system to treat vitreoretinal diseases. The 3D heads-up system was reported to have multiple advantages over the TM system, such as higher magnification, a wider visual field, superior stereoscopic sensation, increased depth of field, improved ergonomic design, and enhanced surgical team communication and education [9][10][11][12][13][14]. However, the application of the 3D heads-up system in the treatment of SMH has not been evaluated.…”

Enhancing surgical precision and efficiency: a study and comparison of a three-dimensional surgical video system in proliferative diabetic retinopathy surgery

“…Notably, pioneers such as Eckardt, Kita, and others laid the foundation by introducing 3D surgical video systems to vitreoretinal surgery. Additionally, comparisons between the 3D surgical video and traditional microscope-based systems have been conducted, indicating similar surgical durations and postoperative outcomes ( 14 , 16 – 19 ). Our study contributes to this evolving field by introducing a novel concept, the “stripping efficiency.” This concept demonstrates the distinct advantages of utilizing a 3D surgical video system in proliferative diabetic retinopathy surgeries.…”