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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, Tex.) 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.
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      References

        • Weinstock RJ
        • Desai N.
        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
        • Eckardt C
        • Paulo EB.
        Heads-up surgery for vitreoretinal procedures: an experimental and clinical study.
        Retina. 2016; 36: 137-147
        • Story C.
        The case for 3-D.
        Retina. 2015; : 76-78
        • Weinstock RJ
        • Diakonis VF
        • Schwartz AJ
        • Weinstock AJ.
        Heads-up cataract surgery: complication rates, surgical duration, and comparison with traditional microscopes.
        J Refract Surg. 2019; 35: 318-322
        • Weinstock RJ
        • Ainslie-Garcia MH
        • Ferko NC
        • et al.
        Comparative assessment of ergonomic experience with heads-up display and conventional surgical microscope in the operating room.
        Clin Ophthalmol. 2021; 15: 347-356
        • Kantor P
        • Matinti F
        • Varenne F
        • et al.
        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
        • Moura-Coelho N
        • Henriques J
        • Nascimento J
        • Dutra-Medeiros M.
        Three-dimensional display systems in ophthalmic surgery: a review.
        Eur Ophthal Rev. 2019; 13: 31
        • Faul F
        • Erdfelder E
        • Lang A-G
        • Buchner A.
        G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences.
        Behav Res Methods. 2007; 39: 175-191
        • Chylack LT
        • Leske C
        • Sperduto R
        • Khu P
        • McCarthy D.
        Lens opacities classification system.
        Arch Ophthalmol. 1988; 106: 330-334
        • Liu J
        • Wu D
        • Ren X
        • Li X.
        Clinical experience of using the NGENUITY three-dimensional surgery system in ophthalmic surgical procedures.
        Acta Ophthalmol. 2021; 99: e101-e108
        • Rizzo S
        • Abbruzzese G
        • Savastano A
        • Caporossi T
        • Barca F.
        Perceptions of the surgical team.
        Retina. 2018; 38: 857-861
        • Kurz S
        • Krummenauer F
        • Gabriel P
        • Pfeiffer N
        • Dick HB.
        Biaxial microincision versus coaxial small-incision clear cornea cataract surgery.
        Ophthalmology. 2006; 113: 1818-1826
        • Lyon JA
        • Garcia-Milian R
        • Norton HF
        • Tennant MR.
        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
        • Harris PA
        • Taylor R
        • Minor BL
        • et al.
        The REDCap Consortium: building an international community of software platform partners.
        J Biomed Inform. 2019; 95103208
        • Nariai Y
        • Horiguchi M
        • Mizuguchi T
        • Sakurai R
        • Tanikawa A.
        Comparison of microscopic illumination between a three-dimensional heads-up system and eyepiece in cataract surgery.
        Eur J Ophthalmol. 2021; 31: 1817-1821
        • Reddy S
        • Mallikarjun K
        • Mohamed A
        • et al.
        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
        • Agranat JS
        • Miller JB
        • Douglas VP
        • et al.
        The scope of three-dimensional digital visualization systems in vitreoretinal surgery.
        Clin Ophthalmol. 2019; 13: 2093-2096
        • Ishida A
        • Sugihara K
        • Shirakami T
        • Tsutsui A
        • Manabe K
        • Tanito M
        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
        • Hoffman DM
        • Girshick AR
        • Akeley K
        • Banks MS.
        Vergence-accommodation conflicts hinder visual performance and cause visual fatigue.
        J Vision. 2008; 8: 1-30
        • Helayel BH
        • Al-Mazidi S
        • AlAkeely A.
        Can the three-dimensional heads-up display improve ergonomics, surgical performance, and ophthalmology training compared to conventional microscopy?.
        Clin Ophthalmol. 2021; 15: 679-686
        • Palacios RM
        • Maia A
        • Farah ME
        • Maia M.
        Learning curve of three-dimensional heads-up vitreoretinal surgery for treating macular holes: a prospective study.
        Int Ophthalmol. 2019; 39: 2353-2359