Eyeworld

Case 1 This patient was 51 years old with a history of ankylosing spondylitis and chronic severe uveitis in both eyes. He had a macula-off retinal detachment with glaucoma to the point of no light perception in his right eye. He had been experienc- ing decreasing vision for 3 years in his left eye. At the time he presented for cataract surgery in his left eye, his uveitis was well controlled with biologics. Dr. Schiefer showed a 3D video of the case, which began with breaking up a dense pupillary membrane, followed by a "beer can" capsulotomy technique, and removal of the cataract with a bimanual phaco technique and judicious cor- tical removal, not confusing the anterior capsule with cortex. The 3D heads-up surgery was advantageous for this case—ergonomically because it was longer (30+ minutes) and visually due to the enhanced depth of field. Ultimately, Dr. Schiefer said this patient did well, especially when you compare the result to the completely synechiated pupil at the beginning of the case. Case 2 This involved a 27-year-old with a history of myopia who received an ICL in both eyes. On postop day 1 there was a high vault as seen on the slit lamp exam and Pentacam (Oculus); IOPs were normal. Dr. Schiefer said she had a 12.6 mm ICL implanted orig- inally, based on white-to-white, but due to the high vault, an ICL exchange was needed with manual trimming of the corners of the new 12.1 mm ICL. The case was performed with the Proveo 8X 3D Digital Microscope (Leica), which Dr. Schiefer said provided nice depth of field and freedom in the Dr. Riemann shared how adjusting light pipe settings, which can be set as low as 5–20% on the screen with the EVA NEXUS (DORC/Zeiss), may reduce phototoxicity risks to the retina. Source: Christopher Riemann, MD working space. "Having a 3D scope was super helpful here," he said. "It would have been more challenging to move ocu- lars back and forth from the patient to the operating table." On postop day 1 after the exchange, the patient was 20/30 and 20/25 with improved vault and normal IOPs. In the panel discussion, Dr. Hovanesian pointed out that one of the benefits of 3D visualization is that everyone in the room (whether it be the OR or the session room) gets the same view as the surgeon, making it a great teaching tool. Screen-Based Vitreoretinal Surgery and Beyond Christopher Riemann, MD, took attendees of the symposium back to 2009, describing what 3D high-definition surgery was like with the early TrueVision machine, followed by a self-built system. At this time, after performing several surgeries, Dr. Riemann said equivalency was shown between the early proof-of-concept digital visualization tools and traditional analog viewing through microscopes. From there, Dr. Riemann said the question became whether machine vision could become better than human vision. "It turns out, yes—17 years later with multiple improvements by many very capable tech companies, we have better ergonomics, better high dynamic range/low light surgery, better signal processing, better stereo, better teaching, better depth of field, and we have the ability to do active aperture management." continued on next page

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