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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References
- Heads-up cataract surgery with the TrueVision 3D display system.in: Garg A Alio JL Surgical techniques in ophthalmology: cataract surgery. New Dehli. Jaypee Medical Publishers, India2010: 124-127
- Heads-up surgery for vitreoretinal procedures: an experimental and clinical study.Retina. 2016; 36: 137-147
- The case for 3-D.Retina. 2015; : 76-78
- Heads-up cataract surgery: complication rates, surgical duration, and comparison with traditional microscopes.J Refract Surg. 2019; 35: 318-322
- Comparative assessment of ergonomic experience with heads-up display and conventional surgical microscope in the operating room.Clin Ophthalmol. 2021; 15: 347-356
- Use of the heads-up NGENUITY 3D visualization system for vitreoretinal surgery: a retrospective evaluation of outcomes in a French tertiary center.Sci Rep. 2021; 11: 10031
- Three-dimensional display systems in ophthalmic surgery: a review.Eur Ophthal Rev. 2019; 13: 31
- G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.Behav Res Methods. 2007; 39: 175-191
- Lens opacities classification system.Arch Ophthalmol. 1988; 106: 330-334
- Clinical experience of using the NGENUITY three-dimensional surgery system in ophthalmic surgical procedures.Acta Ophthalmol. 2021; 99: e101-e108
- Perceptions of the surgical team.Retina. 2018; 38: 857-861
- Biaxial microincision versus coaxial small-incision clear cornea cataract surgery.Ophthalmology. 2006; 113: 1818-1826
- The Use of Research Electronic Data Capture (REDCap) software to create a database of librarian-mediated literature searches.Med Ref Serv Q. 2014; 33: 241-252
- The REDCap Consortium: building an international community of software platform partners.J Biomed Inform. 2019; 95103208
- Comparison of microscopic illumination between a three-dimensional heads-up system and eyepiece in cataract surgery.Eur J Ophthalmol. 2021; 31: 1817-1821
- Comparing clinical outcomes of macular hole surgeries performed by trainee surgeons using a 3D heads-up display viewing system versus a standard operating microscope.Int Ophthalmol. 2021; 41: 2649-2655
- The scope of three-dimensional digital visualization systems in vitreoretinal surgery.Clin Ophthalmol. 2019; 13: 2093-2096
- Observation of Gonio Structures during Microhook Ab Interno Trabeculotomy Using a Novel Digital Microscope with Integrated Intraoperative Optical Coherence Tomography.J Ophthalmol. 2020; : 9024241https://doi.org/10.1155/2020/9024241
- Vergence-accommodation conflicts hinder visual performance and cause visual fatigue.J Vision. 2008; 8: 1-30
- Can the three-dimensional heads-up display improve ergonomics, surgical performance, and ophthalmology training compared to conventional microscopy?.Clin Ophthalmol. 2021; 15: 679-686
- Learning curve of three-dimensional heads-up vitreoretinal surgery for treating macular holes: a prospective study.Int Ophthalmol. 2019; 39: 2353-2359
Article info
Publication history
Published online: September 22, 2021
Accepted:
August 25,
2021
Received in revised form:
July 18,
2021
Received:
April 5,
2021
Identification
Copyright
© 2021 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.