Utilization of Augmented Reality Head-Mounted Display for the Surgical Management of Thoracolumbar Spinal Trauma.

Background and Objectives: Augmented reality head-mounted display (AR-HMD) is a novel technology that provides surgeons with a real-time CT-guided 3-dimensional recapitulation of a patient's spinal anatomy. In this case series, we explore the use of AR-HMD alongside more traditional robotic assistance in surgical spine trauma cases to determine their effect on operative costs and perioperative outcomes. Materials and Methods: We retrospectively reviewed trauma patients who underwent pedicle screw placement surgery guided by AR-HMD or robotic-assisted platforms at an academic tertiary care center between 1 January 2021 and 31 December 2022. Outcome distributions were compared using the Mann-Whitney U test. Results: The AR cohort (n = 9) had a mean age of 66 years, BMI of 29.4 kg/m2, Charlson Comorbidity Index (CCI) of 4.1, and Surgical Invasiveness Index (SII) of 8.8. In total, 77 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 378 mL, 0.78 units transfused, 398 min spent in the operating room, and a 20-day LOS. The robotic cohort (n = 13) had a mean age of 56 years, BMI of 27.1 kg/m2, CCI of 3.8, and SII of 14.2. In total, 128 pedicle screws were placed in this cohort. Intra-operatively, there was a mean blood loss of 432 mL, 0.46 units transfused units used, 331 min spent in the operating room, and a 10.4-day LOS. No significant difference was found between the two cohorts in any outcome metrics. Conclusions: Although the need to address urgent spinal conditions poses a significant challenge to the implementation of innovative technologies in spine surgery, this study represents an initial effort to show that AR-HMD can yield comparable outcomes to traditional robotic surgical techniques. Moreover, it highlights the potential for AR-HMD to be readily integrated into Level 1 trauma centers without requiring extensive modifications or adjustments.

Outcomes and predictive factors in multifocal and extended depth of focus intraocular lens implantation.

PURPOSE OF REVIEW: Options for addressing presbyopia with intraocular lens (IOL) implantation have become more varied and sophisticated. We reviewed recent literature on multifocal and extended depth of focus (EDOF) IOLs in order to provide insight on their respective advantages, with emphasis on the visual outcomes of each design. RECENT FINDINGS: Increased patient age, spectral domain optical coherence tomography (SD-OCT) abnormalities, abnormal optical axis measurements, and better preoperative visual acuity have been implicated as predictors of worse postoperative vision or visual quality in multifocal IOLs. Despite differences in objective outcomes, patient-reported outcomes such as satisfaction are consistently similar between multifocal and EDOF IOLs. EDOFs may have slightly lower rates of spectacle independence than trifocals, but there is more support for their use in the setting of with other ocular conditions. SUMMARY: Multifocal and EDOF IOLs are both viable options for patients who wish to preserve near vision. Given their similar objective performance in many aspects, enabling patients to make informed decisions based on their expectations and visual requirements is critical to postoperative satisfaction. Evidence for advanced technology IOL implantation in pediatric patients remains inconclusive.