To estimate the safety and efficacy of a 3‐D visualization helmet for vitreoretinal surgery

Abstract

To evaluate a 3-D visualization helmet (3DVH) during 23-gauge pars plana vitrectomy (PPV) for macular holes (MH) and macular puckers (MP). Methods: A total of 184 eyes of 184 patients undergoing PPV for MH or MP were randomly selected for surgery with 3DVH or standard Galilean microscope (GM). Only one highly trained surgeon performed each PPV. A surgical comfort score, ranging from 1 to 10 was recorded after each operation. Statistical analysis was run with SPSS to compare parameters before and after surgery and between the two groups. Results: No statistical differences were found between the two groups for mean best correct visual acuity improvement after surgery (p < 0.001). Mean surgery comfort evaluation was 7.63 AE 0.48 in 3DVH eyes and 8.21 AE 0.62 in GM ones (p = 0.09); mean overall surgical time was 35.12 AE 3.8 min in 3DVH eyes and 32.7 AE 2.27 min in GM ones (p < 0.001); mean peeling time was 14.24 AE 3.42 min in 3DVH eyes and 13.61 AE 4.63 min in GM ones (p = 0.11). Conclusions: According to the data observed in this study, the 3DVH provides adequate safety and efficacy in retinal and macular visualization during PPV for MH and MP.

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

“…The 3D heads-up surgery was comparable to the TM surgery in postoperative VA and primary anatomic success rate, which was in accordance with the previous studies [ 3 , 10 , 11 , 16 , 18 , 21 – 23 ]. Although the 3D heads-up system could significantly shorten the duration of ILM peeling for eyes with ERM or idiopathic MH, no significant difference existed in the postoperative VA.…”

“…This might induce intraoperative complications like iatrogenic retinal breaks and require changing intraocular tamponades. Piccirillo et al [ 11 ] reported the occurrence of 3 iatrogenic macular soft contusions in 10 procedures using the 3D heads-up system for vitreoretinal surgery, with no major retinal hemorrhages occurring. Our study found no difference in the incidence of iatrogenic retinal breaks or the choice of vitreous tamponades between the TM group and 3D group, and no differences existed in the occurrence of perioperative complications, including ocular hypertension, VH, RD, and MH.…”

“…The 3D heads-up surgery system was reported to have multiple advantages over the traditional microscopic (TM) system, including high magnification performance, superior stereoscopic sensation, wide visual field, expanded depth of field, and reduced retinal phototoxicity, display image manipulation, improved ergonomics, and enhanced surgical team communication and education [3][4][5][6][7][8][9]. Previously reported disadvantages included the costly equipment, the learning curve required to use it efficiently, and the time latency between surgical interventions and their visualization [10,11], while recent studies found that the time latency of the current 3D heads-up system may not jeopardize the surgical performance and outcome [12,13].…”

“…However, several issues still needed to be settled. (1) Most previous studies evaluating the 3D heads-up system in vitreoretinal surgeries focused only on one single vitreoretinal disease [ 11 , 14 ]. Studies with a larger sample size, multiple vitreoretinal diseases, and more comprehensive analysis were needed to better describe the merit and demerit of the 3D-heads-up system; (2) only a few studies have compared the outcomes of surgeries, for example, visual acuity (VA), primary anatomic success, and postoperative complications between surgeries using the 3D heads-up system and TM equipment, and their sample size was also limited.…”

Three-Dimensional Head-Up Display Versus Standard Operating Microscope for Vitrectomy Surgery

“…A further 18 articles were removed by full-text review because they were not controlled studies or had insufficient data. A total of 15 studies of 15 articles 3,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] (2,889 eyes) met the inclusion and exclusion criteria and were included in the metaanalysis (Figure 1). Among these studies, six studies 3,10,12,15,18,19 were RCTs, two studies 13,23 were prospective non-RCTs, and seven studies 11,12,14,16,17,[20][21][22] were retrospective controlled studies.…”