EyeWorld Asia-Pacific September 2019 Issue

EWAP SEPTEMBER 2019 9 FEATURE H eads-up cataract surgery refers to when the surgeon performs microsurgical procedures by viewing the microscopic ˆ“>}i œ˜ >…ˆ}…‡`iw˜ˆÌˆœ˜ y>Ì «>˜i `ˆÃ«>Þ Ãi˜Ì vÀœ“ a three-dimensional (3D) camera, hence not needing to look down through the microscope eyepiece throughout the operation. -ˆ˜Vi ˆÌ Ü>à wÀÃÌ Ài«œÀÌi` ˆ˜ 2009 by Weinstock 1 , heads-up surgery has gained increasing applications in ophthalmic surgery. Current reports on heads-up surgery mainly focus on vitreoretinal disease as it confers the advantage of lower endoillumination levels >˜`…ˆ}…iÀ `i«Ì…œv wi`° Meanwhile, as the manipulation space of the anterior segment is smaller compared with the posterior segment, cataract surgery via this technique is performed less frequently. In clinical practice, I have performed heads-up cataract surgery for 1 year. Compared with traditional surgery, Heads up for 3D cataract surgery 3D surgery confers many advantages. As it is named, the most obvious one is its ergonomic design, which enables a more physiologically comfortable and stable body posture to relieve fatigue as well as musculoskeletal stress for surgeons and extends their career. Secondly, 3D technology can improve teaching and learning procedures intraoperatively. Observers can share the same stereoscopic surgical experience with the surgeon by wearing passive polarized 3D glasses, which helps them learn more details and improve understanding and knowledge retention. With the development of 5G data transmission technology and virtual reality (VR) technology, I believe that in the near future, ophthalmologists can watch remote cataract surgery broadcasts easily. Besides, heads-up surgery may overcome visualization limitations of standard microsurgery. With the display being approximately 2 meters away from surgeon, compared with looking down through the eyepiece, a wider viewing angle is available to surgeons. They can magnify the ˆ“>}i ̜ >…ˆ}…“>}˜ˆwV>̈œ˜ without experiencing any discomfort or eyestrain under ̅i Ã>“i “>}˜ˆwV>̈œ˜ ̅ÀœÕ}… a microscope. In addition, surgeons can more conveniently have instruments passed from technicians, not just seeing out the corner of the eye. Furthermore, the 3D visualization system can decrease illumination to reduce the risk of phototoxicity and provide an enhanced depth œv wi` ̜ ˆ“«ÀœÛi ÃÕÀ}ˆV> accuracy. However, there is still considerable room for improvement in heads-up surgery. Some 3D visualization systems only retain the heads-up path and cover the microscopic eyepiece. This design may get beginning heads-up surgeons into trouble in complex or unexpected situation. For example, eye socket hydrops occurs more often in patients ܈̅˜>ÀÀœÜ «>«iLÀ> wÃÃÕÀi] resulting in more light ÀiyiV̈œ˜Ã° ˜ ̅ˆÃ VˆÀVՓÃÌ>˜Vi] microsurgical procedures by viewing display can be `ˆvwVÕÌ >˜` ՘Ã>vi° ˜ ÌiÀ“à of visualization system, system delay between steps of surgery and the video projected on `ˆÃ«>Þ ˆÃ `ˆvwVÕÌ Ìœ >ۜˆ`] ܅ˆV… can lead to deviations during more sophisticated operations. The lag is more evident in anterior segment surgeries due to the higher instrument speed during surgical manipulations. Besides, in my experience, due to the learning curve, when the operation has high requirements for distinguishing details such as complicated cases, I prefer to observe directly through ̅i iÞi«ˆiVi ̜ Vœ˜wÀ“ ̅i accuracy. Our heads-up cataract surgeries are performed with the NCVideo3D visualization Contact information Yao: xlren@zju.edu.cn by Yao Ke, MD Eye Institute of Zhejiang University Eye Center