3D vitrectomy. Is it really useful?

Figueroa, M.S.

doi:10.1016/j.oftale.2017.02.011

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(a) Primary retina detachment (PRD). (b) Repeated retina detachment (ReRD). (c) Vitreomacular interface pathology (VMP). (d) Vitreous hemorrhage (VH)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Martín-Avià, P. Romero-Aroca" "autores" => array:2 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Martín-Avià" ] 1 => array:2 [ "nombre" => "P." "apellidos" => "Romero-Aroca" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669116301277" "doi" => "10.1016/j.oftal.2016.07.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669116301277?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579416301517?idApp=UINPBA00004N" "url" => "/21735794/0000009200000006/v1_201705310014/S2173579416301517/v1_201705310014/en/main.assets" ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Editorial" "titulo" => "3D vitrectomy. Is it really useful?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "249" "paginaFinal" => "250" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "M.S. Figueroa" "autores" => array:1 [ 0 => array:2 [ "nombre" => "M.S." "apellidos" => "Figueroa" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Retina, Hospital Universitario Ramón y Cajal, Vissum, Madrid, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vitrectomía 3D. ¿Es realmente útil?" ] ] "textoCompleto" => "In recent years, numerous technological breakthroughs have been achieved in vitreoretinal surgery, including improvements in fluidics and increased cutting speeds that have contributed to enhance the safety and efficacy of surgical procedures. To these improvements we must add a major development in visualization: 3D surgery, which provides surgeons with high-definition stereoscopic vision and improves the perception of depth and spatial orientation.In 3D surgery, oculars are substituted by a high resolution display. Utilizing passive polarized spectacles, the surgeon as well as residents and all surgery staff are able to see the surgical field in 3 dimensions with excellent resolution, field depth, clarity and contrast, which facilitates surgery, explanations and learning.An essential component in the 3D visualization system is the high dynamic range camera. This HD camera, that provides an image quality similar to that of the microscope, turns an optical microscope into a digital system.However, what are the advantages of this system compared to conventional surgical microscopes?The first advantage is greater image magnification, with good resolution and feels depth. The large size of the image in the display facilitates the identification of lesions, maintaining a broad field of vision which enables highly precise surgical maneuvers with excellent visualization conditions, and a latency of only 90ms between the movement under the microscope and the display.An additional advantage of this digital platform is that it enables image manipulations which allows, for example, to reduce the endocular light intensity required during vitrectomy (approximately 20% less), with similar visualization. The surgeon is able to increase the light of the surgical field and display gain without having to expose the patient retina to additional light, thus reducing phototoxicity risks.The digitalization of images also allows diminishing the brightness of instruments and improving the lighting of shadows.In addition, said system applies filters to facilitate intra-surgery visualization of some structures such as fibrovascular proliferations in diabetic retinopathy, epiretinal or internal limiting membranes, which makes unnecessary the use of biological stains in some cases and to enhance stain definition in others.One of the characteristics of said 3-D display, that has been very well received by retina surgeons, is the possibility of visualizing in the display the imaging tests taken in the practice. This allows the integration of multimodal images of the practice and the surgery, which are displayed simultaneously. With hardly a slight deviation of the gaze from the surgical field, the surgeon is able to see pre-surgery OCT or angiographies. Likewise, OCT and other intra-op tests can be displayed.In addition to said advantages (magnification, excellent field depth, endoillumination reduction, elimination of glimmers and shadows, improved visualization of tissue with the use of filters) that are related to the digitalization of images, another advantage of the 3-D system is that it facilitates improvements in the position of the surgeon, which becomes more physiological.Neck and back discomfort is frequent among ophthalmologists, doubtlessly due to unnatural positions to look through microscopes. A paper presented at the Congress of the American Society of Retina Specialists in 2004 found that over 55% of surgeons reported neck and back pain, 21% reported back pains and 8.3% had neck pains.<a class="elsevierStyleCrossRef" href="#bib0015">1</a>As the 3-D system does not utilize microscope viewers, the surgeon has more freedom to maintain a more ergonomic position. This improvement in the posture of the back can reduce fatigue and musculoskeletal alterations.<a class="elsevierStyleCrossRef" href="#bib0020">2</a> However, there still is a lot of room for improvement in this field because the presence of the surgical microscope in front of the surgeon requires placing the display at one side of the stretcher and the ensuing twist of the neck which, even though slight, can become uncomfortable after several hours. Let us hope that in the near future a system that allows placing the display in front of the surgeon will be designed to achieve a genuinely ergonomic position.The above description of the numerous advantages of the 3-D system compared with conventional surgery with optical microscope gives rise to the first question that generally comes to mind, i.e., what is the length of the adaptation period?Switching from the conventional system to 3-D surgery is not a complicated process, and the learning curve is short. A few operations will suffice for the surgeon to feel completely comfortable to carry out highly complex surgical procedures.Most of the surgeons who have tested this system reported that in a short period of time it will become the standard for vitreoretinal surgery. The fact of not having to utilize microscope viewers, digital image processing and visualizing the surgery in large displays are the best reported advantages.And last but not least, it must be noted that some 3-D systems can be utilized with any microscope as well as being compatible with broad field contact and contactless visualization systems." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Figueroa MS. Vitrectomía 3D. ¿Es realmente útil? Arch Soc Esp Oftalmol. 2017;92:249–250." ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Desai UR, Abdulhak MM, Bhatti R. Occupational back and neck problems in vitreoretinal surgeons. Conference presented in: American Society of Retina Specialists Annual Meeting; August 2004; San Diego, CA." ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Heads-up surgery for vitreoretinal procedures: an experimental and clinical study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. Eckardt" 1 => "E.B. Paulo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/IAE.0000000000000689" "Revista" => array:6 [ "tituloSerie" => "Retina" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "137" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26200516" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735794/0000009200000006/v1_201705310014/S2173579417300713/v1_201705310014/en/main.assets" "Apartado" => array:4 [ "identificador" => "5814" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Editorial" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735794/0000009200000006/v1_201705310014/S2173579417300713/v1_201705310014/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173579417300713?idApp=UINPBA00004N"]

ISSN: 2173-5794
e-ISSN: 1989-7286

Archivos de la Sociedad Española de Oftalmología is the official journal of the Ophthalmology Society of Spain, that has over 4,000 members. It gives priority to the publication of basic, translational and clinic research including reviews, original articles, short communications, editorials, letters to the editor and clinic practice guides related to Ophthalmology and its subspecialties. A small section of the journal is reserved for the most relevant papers presented at the annual Congress of the Society. All manuscripts considered for publication are reviewed by expert examiner peers (double blind). The journal is published monthly and even though its official language is Spanish all articles are translated into English to increase the dissemination of scientific information. At present, Archivos is the only Spanish language Ophthalmology journal indexed in PubMed/MEDLINE in addition to other prestigious international databases such as Scopus.

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