Eyeworld

continued on next page much better. I am already doing difficult things. I don't want to struggle with the pedals. I want my depth of focus to be there. The depth of focus [with] NGENUITY is five times normal. The resolution, the clarity, the digital filters, the on- screen metrics—you have everything in front of you. … You want your eyes on the 'road.' If you don't use a 3D digital microscope, I strongly suggest you do." During discussion, Dr. Rosenberg shared that today he does 100% of his cases in 3D. "The future of ophthalmology is going to be layered approaches. … It's going to make us more efficient; it's going to make us better, especially with all the tools that we're already using in the operating room." MIGS: It's All About the View Inder Paul Singh, MD, spoke about the use of heads-up 3D microscopy in the MIGS world. Dr. Singh said his impetus to get a heads-up display was his neck surgery with plate placement; it hurt if he leaned his neck forward toward the oculars. "What I realized very quickly after starting to do heads- up is it's not only the ergonomics that are better, but when you decouple the optics from the screen, you can do a lot of neat things with the screen itself. You can manipulate contrast, colors, overlay, light intensity, color pallets. What that does is it gives you the ability to get a much better view in certain situations." Another feature in which he's found value is intraop- erative OCT. Dr. Singh showed several clips of his use of intraoperative OCT, including a procedure with the iTrack canaloplasty microcatheter (Nova Eye Medical), which dilates Schlemm's canal with viscoelastic. "We now can see The Digital Big Bang Eric Rosenberg, DO, shared a complex case that used the NGENUITY 3D Visualization System (Alcon). The patient was in his 50s and developed a traumatic cataract with iri- dodialysis, which had Dr. Rosenberg assuming there would be zonular instability. To maintain safety in this scenario, Dr. Rosenberg said he adjusted his phaco settings on the Centurion Vision System (Alcon) accordingly. "Now with the full integration of the Centurion and the NGENUITY with SmartCataract platforms, we're able to change those settings on the fly," Dr. Rosenberg said. Dr. Rosenberg showcased the ability to operate at low light settings with this device, mentioning studies that show the benefit of operating at reduced light. At one point during the case, Dr. Rosenberg encoun- tered the zonular instability and had some vitreous coming forward. Dr. Rosenberg stabilized the bag and handled the vitreous with anterior vitrectomy (he noted he prefers a pars plana vitrectomy approach, but in this case the zonular dialysis was small, so he was comfortable with the anterior approach). He used a CTR to gain some capsule stability. He then demonstrated a modified Yamane approach to placing an Ahmed segment prior to conducting cortical cleanup. He placed a three-piece IOL, in case it needed to be scleral sutured due to the possibility of subluxation in the future. After IOL placement, Dr. Rosenberg tackled the iridodialysis using an "in-and-out" technique. "What a privilege to be able to present complex cases like this on the NGENUITY. One interesting thing is, anytime I do have a complex surgery, I electively approach it with my 3D digital microscope. … I elect to do it in my NGENUITY room because detail is so much better, magnification is so Dr. Singh demonstrated how to position the display of a 3D setup so that his shoulders are square to the monitor, avoiding the need to turn his head. Source: Inder Paul Singh, MD

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