Eyeworld

continued from previous page © Copyright 2026 ASCRS Ophthalmic Corporation. All rights reserved. The views expressed here do not necessarily reflect those of the staff and leadership of EyeWorld and ASCRS and in no way imply endorsement by EyeWorld and ASCRS. 3D SURGERY (PRESENTED IN 3D)—IS NOW THE TIME? The Hard Path Made Easier Mark Lobanoff, MD, gave the anterior segment/refractive corneal surgeon's take on heads-up 3D surgery. He detailed removal of the Light Adjustable Lens (LAL, RxSight), which can be tricky for several reasons (it's a thicker, slippery silicone optic that tends to tear into pieces upon removal), and the tools he likes to use, namely larger scissors that help cut the LAL. The 3D visualization with "excellent depth of field" is helpful due to the limited amount of space for tools being used in this IOL's removal. "Having a big bite with big scissors is important, but being able to see where you are in space dimensionally with the digital microscope is very important," Dr. Lobanoff said. Another tip is to put a Sinskey hook behind the optic to provide counter traction to help feed the slippery IOL into the jaws of the microforceps. "The 3D heads-up display has been great," Dr. Lobanoff said. "I operate in an [office-based surgery center], and we use all oral sedation. Because the patients are under oral sedation, they're a little more awake. The beautiful thing about the digital microscope is it has such precise modifica- tion of the digital images that I have excellent acuity in low light. I can bring the light way down, make the patient more comfortable, and see everything that I need." with intraoperative OCT not only the canal but where the collector channels are. Are they getting bigger?" He showed another case where intraoperative OCT gave verification that the MIGS procedure was performed in the right spot and resulted in an anatomical change for the patient. It can be useful for verification of the placement of stents as well. "Fifty percent of stents are not placed in the canal if you look at recent datasets. That's why they don't work; they work when they're placed correctly," Dr. Singh said, noting that intraoperative OCT can show if the stents are in the canal. "We've had cases where I've moved the stents because they were not in the right spot." Another case he showed was placement of the XEN Gel Stent (AbbVie) in relation to Tenon's and the conjunctiva on intraoperative OCT. "To me, it's not just an eye candy device. I use intraoperative OCT to really verify," he said. One pearl Dr. Singh offered for 3D surgery involved body placement in relation to the display. He said one should decouple their body placement from the oculars, squaring their shoulders with the screen so you don't have to turn your head to look at the display. The Beyeonics One 3D headset (Beyeonics) allows surgeons to operate with only infrared light. "Yes, operating in the dark!" Dr. Lobanoff said. Source: Mark Lobanoff, MD Dr. Lobanoff said that 3D heads-up digital displays allow for better posture, improving ergonomics. Source: Mark Lobanoff, MD

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