Research Shows Improved Outcomes With 3D Digital Assisted Cataract Surgery

Cataract surgery assisted by a 3D digital visualization platform leads to less light intensity exposure and fewer complications, as well as a potentially faster postoperative visual recovery, according to research published in the Journal of Cataract and Refractive Surgery. 

Researchers conducted a retrospective pilot study at the Weill Cornell Medical Center in New York between July and November 2019 to investigate whether cataract surgery can be performed safely with a 3D digital visualization system. The investigation also reviewed whether it can be performed safely with significantly lower coaxial light levels than procedures that employ a traditional analog operating microscope. 

Fifty-one consecutive eyes from 35 patients (32 women; mean age, 73.3±8.9 years) were grouped into 2 surgical visualization groups: OPMI Lumera® 700 operating microscope (Zeiss) only or NGENUITY® 3D Visualization System (Alcon) plus the OPMI Lumera 700. Participants were diagnosed with mild or moderate cataract with surgery performed in association with femtosecond laser during the study period. 

Within the cohort, 11 patients had right eye treatment, 8 had left eye treatment, and 16 had bilateral treatment. Twenty-seven eyes had surgery with the OPMI Lumera 700 microscope alone (traditional group) and 24 eyes had surgery with the NGENUITY 3D visualization system plus OPMI Lumera 700 (digital group). Selected light intensity was appropriate for each case. 

No statistically significant difference between the 2 surgical visualization groups was noted by age, sex, or laterality of the surgical eye (P =.52, t test; P =.39, x² test; and P =.41, x² test; respectively). No group experienced intraoperative or postoperative complications, and all participants except 1 in the digital group achieved corrected distance visual acuity of 20/20 by the final postoperative visit.

Mean light exposure time was 25.8±3.0 minutes vs 23.8±1.9 minutes in the traditional vs digital groups, with no statistically significant difference in exposure time. There was a highly statistically significant lower mean light intensity used throughout the duration of each surgery in the digital group (18.5%±1.5%, range, 5%-26% vs 43.3%±3.7%, range, 40% to 80% in the traditional group). 

Investigators analyzed postoperative day 1 (POD1) uncorrected distance visual acuity (UDVA) vs postoperative month 1 (POM1) UDVA in each group and found that POD1 UDVA was within 2 lines of POM1 UDVA in 81.5% and 54.2% of eyes in the digital and traditional groups, respectively.

A further subanalysis of 22 eyes from 11 patients who underwent bilateral successive cataract surgery with digital and traditional visualization in each eye showed that results “largely mirrored” those of the larger group. Mean light intensity was 19.4%±2.4% vs 45.5%±8.2%, respectively. Results also showed that 72.7% of eyes in the digital group achieved POD1 UDVA within 2 lines of the POM1 UDVA compared with 54.5% of eyes in the traditional group. 

Per the researchers, future studies with a prospective, randomized design examining patients both pre- and postoperatively are needed. Special attention, they added, should be paid to patients with scotomas or negative dysphotopsia and those at higher risk of retinal phototoxicity. 

“Light intensity was significantly decreased in patients who underwent cataract surgery assisted by the 3D digital visualization platform without an increase in complications or surgical time, and possibly with a faster postoperative visual recovery,” according to researchers. 

“Given that most surgeons are still routinely operating well above the maximum light exposure limit recommended by surgical microscope manufacturers, any technological advances with the potential of positively impacting surgical safety and outcomes warrant close further examination,” Researchers conclude.

Reference

Rosenberg ED, Nuzbrokh Y, Sippel KC. Efficacy of 3D digital visualization in minimizing coaxial illumination and phototoxic potential in cataract surgery: Pilot study. J Cataract Refract Surg. 2021;47(3):291-296. doi:10.1097/j.jcrs.0000000000000448