Skip to main content

Advertisement

SpringerLink
Log in

Learning curve of three-dimensional heads-up vitreoretinal surgery for treating macular holes: a prospective study

  • Original Paper
  • Published:
International Ophthalmology Aims and scope Submit manuscript

Abstract

Purposes

To compare surgeons’ opinions regarding idiopathic full-thickness macular hole (MH) surgery by using traditional microscopy and three-dimensional (3-D) visualization system. To analyze the required time for pars plana vitrectomy (PPV) and for internal limiting membrane (ILM) rhexis by using both visualization methods. To evaluate anatomical surgical results.

Methods

Four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries for treating MHs. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3-D visualization). The completion time for PPV and ILM rhexis was determined by using both methods. Ergonomics, educational value, image sharpness, depth perception, field of view and technical skills were analyzed through answering a questionnaire.

Results

Forty patients were included in the study. The MH size for surgeon 1, fellows 1, 2 and 3 groups, individually, ranged from 237 to 602 μm; 228 to 590 μm, 271 to 611 μm and 289 to 600 μm, respectively. In the 3-D and in the traditional microscopy subgroups (which includes all 4 physicians on the use of one or the other method), the MH size ranged from 228 to 602 μm and 237 to 611 μm, respectively. Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3-D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Depth perception was rated as similar for both methods. Field of view and educational values were rated as superior when using the 3-D system. Image resolution and ergonomics were rated as superior when using traditional microscopy. Technical skills strongly tended toward ‘superiority’ when using traditional microscopy. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery.

Conclusion

The 3-D system for MH surgery had a short learning curve and was a refined educational tool, when used with reduced illumination and precise focus. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. Heads-up surgery may become a new pattern for ophthalmic surgery as ongoing improvements are applied.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Allen CH, David WF, Jason H et al (2015) The case for 3-D Retina surgery. Retina Today 10(8):76–78

    Google Scholar 

  2. Eckardt C, Paulo EB (2016) Heads-up surgery for vitreoretinal procedures: an experimental and clinical study. Retina 36:137–147

    Article  Google Scholar 

  3. Coppola M et al (2017) Heads-up 3D vision system for retinal detachment surgery. Int J Retina Vitreous 3:46

    Article  Google Scholar 

  4. Rodrigues EB et al (2007) Vital dyes for chromovitrectomy. Curr Opin Ophthalmol 18:179–187

    Article  Google Scholar 

  5. Rodrigues EB, Meyer CH, Kroll P (2005) Chromovitrectomy: a new field in vitreoretinal surgery. Graefes Arch Clin Exp Ophthalmol 243:291–293

    Article  Google Scholar 

  6. Stem MS et al (2017) Heads-up 3-D visualization in complex vitreoretinal surgery. Retina Today 12(5):44–48

    Google Scholar 

  7. Charles S (2017) Getting specific about 3-D visualization. Retina Today 12(8):48–49

    Google Scholar 

  8. Berrocal M, Figueroa M, Packo K, Rizzo S (2016) A new way to see the big picture in a micro environment. Insert Retina Today 3:4–7

    Google Scholar 

  9. Yoshihiro Y (2016) Seeing the world through 3-d glasses. Retina Today 11(7):54–60

    Google Scholar 

  10. Mendez BM et al (2016) Heads-up 3D microscopy: an ergonomic and educational approach to microsurgery. Plast Reconstr Surg Glob Open 4:1–4

    Article  Google Scholar 

  11. Weinstock RJ (2011) Operate with your head up. Cataract Refract Surg Today 8:66–74

    Google Scholar 

  12. Dhimitri KC, McGwin G, McNeal SF et al (2005) Symptoms of musculoskeletal disorders in ophthalmologists. Am J Ophthalmol 139:179–181

    Article  Google Scholar 

  13. Charles S (2008) Illumination and phototoxicity issues in vitreoretinal surgery. Retina 28:1–4

    Article  Google Scholar 

  14. Adam MK, Thornton S, Regillo CD et al (2017) Minimal endoillumination levels and display luminous emittance during three-dimensional heads-up vitreoretinal surgery. Retina 37:1746–1749

    Article  Google Scholar 

Download references

Acknowledgements

The authors have no financial interest in any aspect of this report.

Author information

Authors and Affiliations

  1. Department of Ophthalmology-Retina, Federal University of São Paulo, Alameda Santos, 333 - Apto 142, São Paulo, SP, CEP 01419-000, Brazil

    Renato Menezes Palácios, Andre Maia, Michel Eid Farah & Mauricio Maia

Authors
  1. Renato Menezes Palácios
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andre Maia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michel Eid Farah
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mauricio Maia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Renato Menezes Palácios.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Palácios, R.M., Maia, A., Farah, M.E. et al. Learning curve of three-dimensional heads-up vitreoretinal surgery for treating macular holes: a prospective study. Int Ophthalmol 39, 2353–2359 (2019). https://doi.org/10.1007/s10792-019-01075-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10792-019-01075-y

Keywords

Search

Navigation