Heads-Up Three-Dimensional Viewing Systems in Vitreoretinal Surgery: An Updated Perspective.

Three-Dimensional (3D) heads-up visualization systems have significantly advanced vitreoretinal surgery, providing enhanced detail and improved ergonomics. This review discusses the application of 3D systems in vitreoretinal surgery, their use in various procedures, their combination with other imaging modalities, and the role of this technology in medical education and telementoring. Furthermore, the review highlights the benefits of 3D systems, such as improved ergonomics, reduced phototoxicity, enhanced depth of field, and the use of color filters. Potential challenges, including the learning curve and additional costs, are also addressed. The review concludes by exploring promising future applications, including teleophthalmology for remote assistance and specialist availability expansion, virtual reality integration for global clinical education, and the combination of remotely robotic-guided surgery with artificial intelligence for precise, efficient surgical procedures. This comprehensive review offers insights into the current state and future potential of 3D heads-up visualization systems in vitreoretinal surgery, underscoring the transformative impact of this technology on ophthalmology.

Image sharpening algorithms improve clarity of surgical field during 3D heads-up surgery.

BACKGROUND: Image-sharpening algorithms with color adjustments enable real-time processing of the surgical field with a delay of 4 msec for heads-up surgery using digital three-dimensional displays. The aim of this study was to investigate the usefulness of the algorithms with the Artevo 800® digital microscope. METHODS: Seven vitreoretinal surgeons evaluated the effects of image-sharpening processing on the clarity of the surgical field with the Artevo 800® system that is used for cataract and vitreous surgeries. The scorings were made on a 10-point scale for anterior capsulotomy, phacoemulsification, cortex aspiration, core vitrectomy, and peeling of an epiretinal membrane or an internal limiting membrane. In addition, the images during the internal limiting membrane peeling were processed with or without color adjustments. We also evaluated the skewness (asymmetry in the distribution of the pixels) and kurtosis (sharpness in the distribution of the pixel) of the images to evaluate the contrast with each intensity of image-sharpening. RESULTS: Our results showed that the mean visibility score increased significantly from 4.9 ± 0.5 at 0% (original image) to 6.6 ± 0.5 at 25% intensity of the image-sharpening algorithm (P < 0.01). The visibility scores of the internal limiting membrane increased significantly from 0% (6.8 ± 0.3, no color adjustments) to 50% after the color adjustments (7.4 ± 0.4, P = 0.012). The mean skewness decreased significantly from 0.83 ± 2.02 at 0% (original source) to 0.55 ± 1.36 at 25% intensity of the image-sharpening algorithm (P = 0.01). The mean kurtosis decreased significantly from 0.93 ± 2.14 at 0% (original image) to 0.60 ± 1.44 at 25% intensity of the image-sharpening algorithm (P = 0.02). CONCLUSIONS: We conclude that the image-sharpening algorithms can improve the clarity of the surgical field during 3D heads-up surgery by decreasing the skewness and kurtosis. TRIAL REGISTRATION: This was a prospective clinical study performed at a single academic institution, and the procedures used were approved by the Institutional Review Committee of the Kyorin University School of Medicine (reference number, 1904). The procedures also conformed to the tenets of the Declaration of Helsinki.

Vitrectomy Combined with Cataract Surgery for Retinal Detachment Using a Three-Dimensional Viewing System.

PURPOSE: To evaluate the results of a pars plana vitrectomy (PPV) combined with cataract surgery for primary rhematogenous retinal detachment (RD) using a three-dimensional (3D) viewing system and a conventional microscope (CM). METHODS: Medical reports of 82 patients were retrospectively reviewed: 26 patients were operated on with 3D and 56 patients were operated on with CM. The main outcome measures were visual acuity, duration of the surgery, and the rate of postoperative complications. RESULTS: No statistically significant differences in pre- and postoperative visual acuity were found between both groups. There was significant improvement in the visual acuity in both groups. The best postoperative visual acuity was achieved with SF6 gas tamponade, followed by C3F8 gas and silicone oil in both groups. The duration of the surgery (60 min vs. 55 min) and the rate of postoperative complications (15% vs. 14%) were similar in both groups. CONCLUSIONS: The similar postoperative visual acuity and rate of complications detected using 3D and CM indicate that the 3D viewing system may be advantageous in the treatment of rhematogenous RD with PPV combined with cataract surgery, i.e., a complex procedure involving both anterior and posterior segment manipulations.

Clinical experience of using the NGENUITY three-dimensional surgery system in ophthalmic surgical procedures.

PURPOSE: To assess the clinical experience of using a three-dimensional (3D) system for ophthalmic surgical procedures. METHODS: We retrospectively analysed video recordings of patients who underwent 3D ophthalmic surgery, using the NGENUITY® 3D visualization system, or traditional microsurgery at our hospital, from August 2017 to February 2018. Patients underwent phacoemulsification or phacoemulsification combined with vitrectomy. Diagnoses, operation type, duration of continuous curvilinear capsulorhexis (CCC), number of forceps nips during CCC and capsulorhexis complications were recorded. Five surgeons and four assistants answered a 3D surgery questionnaire. RESULTS: Twenty-six of 46 patients who underwent 3D surgery, and 31 of 51 patients who underwent traditional microsurgery (control group) were enrolled. The mean CCC duration in the study and control groups was 31.2 ± 10.8 and 28.7 ± 13.2 seconds (p = 0.071), and the mean number of forceps nips was 5 ± 2 and 5 ± 2 (p = 0.634), respectively. The anterior capsular rupture rate of phacoemulsification under 3D and traditional conditions was 3.85% (1/26 cases) and 3.23% (1/31 cases), respectively. The complication rate was similar between the two groups (p > 0.999). Four of five surgeons and two of four assistants believed the clarity of 3D surgery was similar or better than that of traditional microsurgery. The occurrence of dizziness (p > 0.999), shoulder and neck pain (p = 0.262), backache (p = 0.471) and visual fatigue (p = 0.347) did not differ significantly between the two methods. CONCLUSION: The 3D surgical system facilitated similar operation speed and stability as the traditional microscope and provided reliable support for ophthalmic surgery.

Vitrectomy in high myopia: a narrative review.

Pathologic myopia is associated with degenerative changes of the globe, especially at the posterior pole. Eyes affected by pathologic myopia have higher odds to undergo posterior segment surgery and, in those eyes, vitreoretinal surgery is challenging. Many practical tips and tricks can make the surgical procedures simpler, significantly preventing sight-threatening intra- and post-operative complications. Moreover, novel surgical techniques and technological advancements (i.e. ad-hoc instrumentation, minimally invasive vitreoretinal surgery, filters, dye staining, intraoperative optical coherence tomography and 3-dimensional surgery) may play role in highly myopic eyes. The aim of the present work is to review practical tips and tricks, novel surgical techniques and technological advancements.

Prospective observational study comparing traditional laparoscopy and three-dimensional laparoscopy in gynecologic surgery.

OBJECTIVE: To compare perioperative details among patients who underwent gynecologic surgery between traditional laparoscopy and three-dimensional laparoscopy. METHODS: The present prospective non-randomized study enrolled all consecutive patients diagnosed with gynecologic pathology who underwent laparoscopic surgery at Reina Sofia Hospital, Cordoba, Spain between January 1 and April 30, 2014. Perioperative data, adverse events, and patient satisfaction were compared between patients who underwent treatment with two-dimensional and three-dimensional laparoscopic surgery techniques. RESULTS: The study enrolled 60 consecutive patients; 31 (52%) patients who underwent three-dimensional surgery and 29 (48%) who underwent traditional two-dimensional surgery. No significant differences were observed in the adverse-event rate, operating time, or perioperative parameters. A higher use of sealing devices was recorded among patients who underwent three-dimensional laparoscopy (P=0.021). No difference was recorded in patient satisfaction between the two patient groups. CONCLUSION: Although there was no impact on surgical outcomes, three-dimensional surgery could give a more accurate view of the surgical field. Performing three-dimensional surgery could be beneficial for more complex procedures although further comparative studies are required to investigate this hypothesis.