First Author: H.Gerding SWITZERLAND
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It was the aim of this study 1. to review the development of devices for heads-up ophthalmic surgery so far, 2. to analyze available information and own clinical test experience applying 3-D monitors in anterior and posterior segment ocular interventions, 3. to describe the contemporary role of available heads-up ophthalmic systems, and 4. to present an outlook on potential developments in the future.
After database and general web search of available information a meta-analysis of information was performed. Retrospectively, institutional tests of two different 3D-heads-up systems in two case series were analyzed.
A PubMed and internet based literature search was performed in order to identify all presently available information on the use of 3D heads-up devices in ophthalmic surgery and the in other medical disciplines. Clinical experience with our first self-designed system (D3D) of 2002, based on an autostereoscopic monitor (Dresden 3D) were analyzed and compared to the recently available NGENUITY (NG) system, implementing a polarized LCD screen viewed via passive polarizing glasses.
In 2002 first clinical tests were performed with our D3D-system based on a 18.1``. (1280x1024 pixel) autostereoscopic monitor (Dresden 3D). From 2006 on True Vision Systems developed the NGENUITY-system (NG) which became recently (9/2016) available. NG is based on a 55´´ 4k ultra HD flat panel display (resolution: 3840x2160), viewed via passive polarizing glasses. Beside web-based documents, only two clinical reports are available in PubMed. The results and own experiences can be summarized as follows: Both systems can immediately be used for anterior/posterior segment interventions without previous training. They provide a hyper-stereoscopic effect and expanded field of depth allowing higher magnification and by this providing better stereoscopic localization of the ILM and membranes. Light exposure can be reduced significantly by amplification of image signals. A wide range of parameter settings (colour, contrast, gamma correction) are available in NG and can be stored for different surgical task. Minor reduction in optical resolution of both systems can be compensated by increasing microscopic magnification. Surgeons described the heads-up position as much more comfortable. The D3D-unit does not necessitate glasses. On the other hand it can be used only by the surgeon, whereas the NG-screen can be shared by the whole team.
NGENUITY has reached a status of developmental maturity which allows an immediate clinical use without training. The hyper-stereoscopic effect and extended field of depth provides the option to work at higher microscopic magnification and by this to improve delicate tissue localization (ILM, membranes). By this NG may be become an alternative to intraoperative OCT use. Amplification of the over all electronic image and separate adjustment of colours allows to reduce the over all and especially the low wavelength light exposure of eyes during surgery. An overlay of preoperative images (OCTs, angiographic images), optical data (K-values and meridians) and other data seem to be future options that might expand the versatility of the system further.