Evaluation of new approach to enhance visualization performance in cataract surgery: 3D visualization system with coaxial illumination.

PURPOSE: To evaluate the visualization performance of different approaches, including the 3D visualization system with coaxial illumination and the 3D system or microscope with standard illumination. SETTING: Fuzhou Eye Hospital, Fuzhou City, China. DESIGN: Cross-sectional study. METHODS: This 2-part performance assessment for visualization composed of an objective analysis using surgical video images and a subjective survey collecting feedback from surgeons. Data of each eye were obtained with 3 approaches: standard operating microscope with standard illumination (SOM-S), 3D visualization system with standard illumination (3D-S), and 3D visualization system with coaxial illumination (3D-C). RESULTS: 112 eyes (107 cases) and 6 cataract surgeons were involved. The red reflex value was markedly greater in the 3D-C approach compared with other 2 approaches ( P < .001). Compared with the SOM-S approach, the red reflex increased by 55%, 57%, and 53% in the 3D-C approach, corresponding to nuclear grades of II, III, and IV, respectively. In the questionnaire survey, red reflex scores were consistently significantly higher in the 3D-C approach than those in the others ( P < .001). Depth of field was enhanced in both 3D approaches compared with the SOM-S approach ( P < .05). The only minor advantage of the SOM system over the 3D-C approach was in the surrounding field clarity score, and the difference was not statistically significant ( P = 1.000). CONCLUSIONS: The 3D-C approach significantly increased the red reflex in both objective and subjective assessments. Surgeon responses also showed a superior performance for the 3D-C approach.