Abstract
Purpose :
A recently developed digitally assisted vitreoretinal surgery (DAVS) system is known as having potential ergonomic benefits. We performed a prospective, comparative study to quantitatively compare surgical ergonomics and performances between the DAVS and standard operating microscope (SOM) during pars plana vitrectomy (PPV).
Methods :
A single surgeon conducted the procedure on 104 patients; 50 patients underwent PPV using DAVS (DAVS group) and the other 54 patients underwent PPV using SOM (SOM group). Muscle tone and stiffness of the sternocleidomastoid (SCM) and the two positions of the upper trapezius (UT), which are 2-cm intervals along the UT muscle fibers, UT1 and UT2, were measured at preoperative, intraoperative, and postoperative time points. Customized color settings are as follows: Red 100%, Green 100%, Blue 100%, Hue +20, Saturation 90%, and Gamma 1.2. Color contrast ratio (CCR) of internal limiting membrane (ILM) with different indocyanine green (ICG) concentrations (0.0125, 0.025, 0.05, and 0.075%) was measured in DAVS and SOM group, respectively. Total surgical time, surgical time required to complete ILM peeling, and total number of surgical attempts for ILM peeling were analyzed. All patients underwent ophthalmologic examinations including best-corrected visual acuity (BCVA) at baseline and at 3 months postoperatively.
Results :
In the SOM group, intraoperative muscle tone and stiffness were higher than preoperative and postoperative values in the SCM, UT1, and UT2. By contrast, in the DAVS group, there were no differences in muscle properties between any time points. While ILM was visible at 0.0125% ICG concentration in the DAVS group, the SOM was not able to visualize ILM. In 0.025% and 0.05% ICG concentrations, the macular CCR was higher in the DAVS group compared to the SOM group. Both groups did not differ in the total surgical time, ILM peeling time, and ILM grasps attempts in each ICG concentration. Postoperative BCVA and complications did not differ between the two groups.
Conclusions :
This study shows the DAVS reduced intraoperative muscle fatigue of surgeons. Furthermore, the customized DAVS setting enabled surgeons to use 4-fold lower ICG concentration in ILM peeling.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.