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Original Article| Volume 58, ISSUE 2, P162-167, April 2023

Comparison of novel digital microscope using integrated intraoperative OCT with Ngenuity 3D visualization system in phacoemulsification

  • Alfonso Savastano
    Correspondence
    Correspondence to Matteo Ripa, MD, Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University “Sacro Cuore,” Largo A Gemelli, 8-00168 Rome, Italy
    Affiliations
    Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy

    Catholic University “Sacro Cuore,” Rome, Italy
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  • Matteo Ripa
    Affiliations
    Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy

    Catholic University “Sacro Cuore,” Rome, Italy
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  • Maria Cristina Savastano
    Affiliations
    Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy

    Catholic University “Sacro Cuore,” Rome, Italy
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  • Umberto De Vico
    Affiliations
    Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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  • Tomaso Caporossi
    Affiliations
    Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy

    Catholic University “Sacro Cuore,” Rome, Italy
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  • Raphael Kilian
    Affiliations
    Ophthalmology Unit, University of Verona, Verona, Italy
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  • Stanislao Rizzo
    Affiliations
    Ophthalmology Unit, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy

    Catholic University “Sacro Cuore,” Rome, Italy

    Istituto di Neuroscienze, Consiglio Nazionale delle Ricerche, Pisa, Italy
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Published:September 22, 2021DOI:https://doi.org/10.1016/j.jcjo.2021.08.017

      Abstract

      Objective

      To compare surgical efficiency, visual and physical comfort, and safety profile of the ARTEVO 800 Digital Microscope (Carl Zeiss Meditec AG, Jena, Germany) and the Ngenuity 3D Visualization System (Alcon Laboratories Inc, Fort Worth, TX) in cataract surgery.

      Design

      Cross-sectional study.

      Participants

      One hundred consecutive phacoemulsification cataract surgeries performed by five surgeons from June 1, 2020, to November 1, 2020.

      Methods

      For each case, the surgeons answered a 2-section questionnaire (before and after intervention) to collect data on cataract severity or grade, surgical risk, chosen three-dimensional (3D) visualization system, surgical complications, and the visual or physical discomfort experienced during the procedure.

      Results

      Each of the 5 surgeons performed 20 surgeries (N = 100) using either the ARTEVO 800 Digital Microscope (N = 50) or the Ngenuity Visualization System (N = 50). Mean duration of the surgical procedure was 17.07 ± 4.80 minutes, and none of the surgeons ever switched to the classical microscope. In addition, 40% of surgeries were considered at low risk, 30% at intermediate risk, and 30% at high risk. The Zoom, Focus, and XY commands were used 1–3 times, respectively, during 76 (p = 0.34), 73 (p = 0.49), and 76 (p = 0.64) interventions. Surgical uncertainty and operative fluency were similar using both systems (p = 0.53 and p = 0.19). We observed 14 intraoperative complications, 9 using Ngenuity and 5 using the ARTEVO 800. Surgeon's visual comfort (p = 0.79), colour or brightness perception (p = 0.82), and visual impairment (p = 0.62) during surgery were similar for both systems. Headache, backache, and other musculoskeletal problems were reported, respectively, after 14 (p = 0.79), 11 (p = 0.99), and 8 (p = 0.44) procedures.

      Conclusion

      Both the Ngenuity 3D Visualization System (Alcon Laboratories Inc) and the ARTEVO 800 Digital Microscope (Carl Zeiss Meditec AG) provided comparable operative speed and overall surgical comfort during cataract surgery.

      Résumé

      Objectif

      Comparer le microscope numérique ARTEVO 800 (Carl Zeiss Meditec AG, Iéna, Allemagne) et le système de visualisation tridimensionnelle (3D) Ngenuity (Alcon Laboratories Inc., Fort Worth, TX) en matière d'efficacité chirurgicale, de confort visuel et physique et d'innocuité pendant une chirurgie de la cataracte.

      Nature

      Étude transversale.

      Participants

      Cent chirurgies de la cataracte par phacoémulsification consécutives réalisées par 5 chirurgiens entre le 1er juin 2020 et le 1er novembre 2020.

      Méthodes

      Les chirurgiens ont répondu à un questionnaire en 2 sections (avant et après l'intervention) pour chaque patient afin de recueillir les données suivantes : gravité ou grade de la cataracte, risque chirurgical, système de visualisation 3D utilisé, complications chirurgicales et inconfort visuel ou physique ressenti pendant l'intervention.

      Résultats

      Chacun des 5 chirurgiens a réalisé 20 interventions (N = 100) à l'aide du microscope numérique ARTEVO 800 (n = 50) ou du système de visualisation 3D Ngenuity (n = 50). En moyenne, les interventions ont duré 17,07 ± 4,80 minutes, et aucun des chirurgiens n'a eu recours au microscope classique. On estimait que le risque était faible dans 40 % des chirurgies, intermédiaire dans 30 % des chirurgies et élevé dans 30 % des chirurgies. Les commandes zoom, mise au foyer (focus) et XY ont été utilisées de 1 à 3 fois, respectivement, lors de 76 (p = 0,34), de 73 (p = 0,49) et de 76 (p = 0,64) interventions. Le degré d'incertitude chirurgicale et la maîtrise opérationnelle étaient semblables lors de l'utilisation des 2 appareils (p = 0,53 et p = 0,19). Il s'est produit 14 complications intraopératoires (9 dans le groupe Ngenuity et 5 dans le groupe ARTEVO 800). Le confort visuel du chirurgien (p = 0,79), sa perception de la couleur ou de la luminosité (p = 0,82) et la difficulté à voir (p = 0,62) pendant l'intervention étaient semblables pour les 2 appareils. Les chirurgiens ont signalé des céphalées, des douleurs dorsales et d'autres troubles musculosquelettiques après 14 (p = 0,79), 11 (p = 0,99) et 8 (p = 0,44) interventions, respectivement.

      Conclusion

      Le système de visualisation 3D Ngenuity et le microscope numérique ARTEVO 800 se sont révélés comparables quant à la vitesse opératoire et au confort chirurgical global pendant la chirurgie de la cataracte.
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