Palácios Renato Menezes, Maia Andre, Farah Michel Eid, Maia Mauricio
Department of Ophthalmology-Retina, Federal University of São Paulo, Alameda Santos, 333 - Apto 142, São Paulo, SP, CEP 01419-000, Brazil.
Int Ophthalmol. 2019 Oct;39(10):2353-2359. doi: 10.1007/s10792-019-01075-y. Epub 2019 Jan 23.
To compare surgeons' opinions regarding idiopathic full-thickness macular hole (MH) surgery by using traditional microscopy and three-dimensional (3-D) visualization system. To analyze the required time for pars plana vitrectomy (PPV) and for internal limiting membrane (ILM) rhexis by using both visualization methods. To evaluate anatomical surgical results.
Four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries for treating MHs. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3-D visualization). The completion time for PPV and ILM rhexis was determined by using both methods. Ergonomics, educational value, image sharpness, depth perception, field of view and technical skills were analyzed through answering a questionnaire.
Forty patients were included in the study. The MH size for surgeon 1, fellows 1, 2 and 3 groups, individually, ranged from 237 to 602 μm; 228 to 590 μm, 271 to 611 μm and 289 to 600 μm, respectively. In the 3-D and in the traditional microscopy subgroups (which includes all 4 physicians on the use of one or the other method), the MH size ranged from 228 to 602 μm and 237 to 611 μm, respectively. Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3-D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Depth perception was rated as similar for both methods. Field of view and educational values were rated as superior when using the 3-D system. Image resolution and ergonomics were rated as superior when using traditional microscopy. Technical skills strongly tended toward 'superiority' when using traditional microscopy. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery.
The 3-D system for MH surgery had a short learning curve and was a refined educational tool, when used with reduced illumination and precise focus. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. Heads-up surgery may become a new pattern for ophthalmic surgery as ongoing improvements are applied.
比较外科医生对使用传统显微镜和三维（3-D）可视化系统进行特发性全层黄斑裂孔（MH）手术的看法。分析使用两种可视化方法进行玻璃体切割术（PPV）和内界膜（ILM）撕开所需的时间。评估手术解剖结果。
四位外科医生（外科医生1、研究员1、2、3）共进行了40例治疗MH的手术。每人进行10例手术（5例使用传统显微镜，5例使用3-D可视化）。使用两种方法确定PPV和ILM撕开的完成时间。通过回答问卷分析人体工程学、教育价值、图像清晰度、深度感知、视野和技术技能。
40名患者纳入研究。外科医生1、研究员1、2和3组的MH大小分别为237至602μm；228至590μm、271至611μm和289至600μm。在3-D和传统显微镜亚组中（包括所有4位使用一种或另一种方法的医生），MH大小分别为228至602μm和237至611μm。使用两种方法进行全PPV和ILM撕开的平均时间比较无统计学意义，在每位外科医生的每例3-D手术中均如此。外科医生1总是比他带的研究员快。两种方法的深度感知评分相似。使用3-D系统时，视野和教育价值评分更高。使用传统显微镜时，图像分辨率和人体工程学评分更高。使用传统显微镜时，技术技能强烈倾向于“更优”。36例（90%）全层MH通过一次手术成功闭合。
用于MH手术的3-D系统学习曲线短，在降低照明和精确聚焦使用时是一种完善的教育工具。关于MH手术，抬头法在手术时间和解剖手术结果方面与传统显微镜相似。随着不断改进，抬头手术可能成为眼科手术的新模式。
