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      The Scope Of Three-Dimensional Digital Visualization Systems In Vitreoretinal Surgery

      brief-report

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          Abstract

          Introduction

          Significant advances in three-dimensional (3D) imaging technology have allowed for the incorporation of 3D digital displays into medical and surgical devices. Despite initial adoption of the NGENUITY ® 3D Visualization System in vitreoretinal surgery, there are limited publications regarding its use. The generally accepted main benefits include improved ergonomics, enhanced surgical team communication and education, reduced retinal phototoxicity, increased depth of field, and display image manipulation. Despite these potential benefits, many retina specialists have questioned its universal applicability to a wide variety of vitreoretinal surgeries.

          Objective

          To report on the variety of indications and surgical efficacy of the NGENUITY ® 3D Visualization System in vitreoretinal surgery via a review of surgical experience at two vitreoretinal practices in both the academic and community settings.

          Methods

          A retrospective review was conducted of consecutive surgical cases performed on the NGENUITY ® 3D Visualization System at Massachusetts Eye and Ear Infirmary and Florida Retina Institute from June 1st, 2017 to November 1st, 2018. Age, presenting diagnosis, surgical procedure, and intraoperative details were recorded.

          Results

          272 vitreoretinal surgeries on the Alcon NGENUITY ® 3D Visualization System were identified between June 1st, 2017 and November 1st, 2018 at the participating institutions. A detailed breakdown of the indications for surgery and related procedures is reported. During all 272 cases on the 3D digital system, there were no complications attributed to the visualization system.

          Conclusion

          This series illustrates the diversity of vitreoretinal surgeries that can be performed on this system without compromising surgical viewing or increasing surgical complications. The Alcon NGENUITY ® 3D Visualization System possesses favorable ergonomics, illumination levels, depth of field, display filters, and trainee experience.

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          Most cited references11

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          HEADS-UP SURGERY FOR VITREORETINAL PROCEDURES: An Experimental and Clinical Study.

          Claus Eckardt, Erica B Paulo (2016)
          To investigate the feasibility of performing vitrectomies while viewing a three-dimensional image on a large display in a heads-up position.
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            MINIMAL ENDOILLUMINATION LEVELS AND DISPLAY LUMINOUS EMITTANCE DURING THREE-DIMENSIONAL HEADS-UP VITREORETINAL SURGERY.

            Murtaza K. Adam, Sarah Thornton, Carl Regillo … (2017)
            To determine minimal endoillumination levels required to perform 3-dimensional heads-up vitreoretinal surgery and to correlate endoillumination levels used for measurements of heads-up display (HUD) luminous emittance.
            Article 0 comments Cited 28 times – based on 0 reviews     Review now
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              Comparison of clinical outcomes between “heads-up” 3D viewing system and conventional microscope in macular hole surgeries: A pilot study

              Atul Kumar, Nasiq Hasan, Prateek Kakkar … (2018)
              Purpose: To compare clinical outcomes of patients undergoing macular hole surgery with heads-up three-dimensional (3D) viewing system and conventional microscope. Methods: In all, 50 eyes of 50 patients with stage 3 or 4 macular hole were randomized and macular hole surgery [inverted internal limiting membrane (ILM) flap technique] was performed in 25 eyes using 3D viewing system and 25 eyes using conventional microscope. All surgeries were performed by a single surgeon. Patients were followed up for a period of 3 months. Logarithm of the minimum angle of resolution (logMAR) visual acuity, macular hole index, intraoperative parameters such as total surgical time, total ILM peel time, number of flap initiations, duration of Brilliant Blue G dye exposure, illumination intensity, postoperative logMAR visual acuity, and macular hole closure rates were recorded and compared between the two groups. Results: The mean age was 67.92 ± 7.95 and 67.96 ± 4.78 years in both groups, respectively (P = 0.98). Gender (P = 0.38) and right versus left eye (P = 0.39) were also comparable. Preoperative and postoperative best-corrected visual acuity (P = 0.86, 0.92), macular hole index (P = 0.96), total surgical time (P = 0.56), total ILM peel time (P = 0.49), number of flap initiations (P = 0.11), and macular hole closure rates (P = 0.61) were not statistically significant when compared between the two groups. Illumination intensity of microscope (100% vs 45%) and endoillumination (40% vs 13%) were significantly less in the 3D viewing system. Conclusion: The clinical outcomes of macular hole surgery using 3D viewing system are not inferior to that of conventional microscopes, and it has the added advantages of better ergonomics, reduced phototoxicity, peripheral visualization, magnification, and less asthenopia, and it serves as a good educational tool.
              Article 0 comments Cited 22 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Clin Ophthalmol
                Journal ID (iso-abbrev): Clin Ophthalmol
                Journal ID (publisher-id): OPTH
                Journal ID (pmc): clinop
                Title: Clinical Ophthalmology (Auckland, N.Z.)
                Publisher: Dove
                ISSN (Print): 1177-5467
                ISSN (Electronic): 1177-5483
                Publication date (Electronic): 24 October 2019
                Publication date Collection: 2019
                Volume: 13
                Pages: 2093-2096
                Affiliations
                [1 ]Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School , Boston, MA, USA
                [2 ]Florida Retina Institute , Orlando, FL, USA
                Author notes
                Correspondence: Samuel K Houston III Florida Retina Institute , 95 Columbia Street, Orlando, FL32806, USATel +1 407-404-1597 Email shouston@floridaretinainstitute.com
                Author information
                http://orcid.org/0000-0001-5310-0353
                http://orcid.org/0000-0003-0109-9738
                Article
                Publisher ID: 213834
                DOI: 10.2147/OPTH.S213834
                PMC ID: 6818135
                PubMed ID: 31749606
                SO-VID: 35492173-1373-4a9b-83d0-9e1226d0b631
                Copyright © © 2019 Agranat et al.
                License:

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                Date received : 29 April 2019
                Date accepted : 10 September 2019
                Page count
                Tables: 1, References: 11, Pages: 4
                Categories
                Subject: Short Report

                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: heads-up display,3-d visualization,ngenuity,retina,surgery
                Data availability:
                ScienceOpen disciplines: Ophthalmology & Optometry
                Keywords: heads-up display, 3-d visualization, ngenuity, retina, surgery

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