Horigome Yuka, Iwashita Yume, Hirono Kazushi, Inoue Tatsuya, Konno Ami, Kadonosono Kazuaki, Yanagi Yasuo
Department of Ophthalmology and Microtechnology, Yokohama City University School of Medicine, Kanagawa, Japan; and.
Department of Ophthalmology, Asahikawa Medical University, Hokkaido, Japan.
Retina. 2022 Dec 1;42(12):2301-2306. doi: 10.1097/IAE.0000000000003621.
To investigate the retinal light hazard during macular surgery using a digital three-dimensional visualization system (3D) and a conventional microscope (CM).
Experimental study and retrospective evaluation of a case-control study.
A total of 20 and 10 patients who underwent pars plana vitrectomy for epiretinal membrane using 3D and CM, respectively.
Spectral irradiances of endoilluminators were measured for representative settings used during core vitrectomy and macular manipulations with 3D and CM. From the medical record of the patients, time needed for core vitrectomy and macular manipulations was extracted. The total retinal light hazard index and the macular hazard index were calculated based on the spectral irradiances weighted by the standard functions. Total retinal light hazard index, macular hazard index, and the number of cases that exceeded the maximum permissible radiant power exposure were compared between the two groups.
The spectral irradiance were 1.6 and 3.9 mW/cm 2 for core vitrectomy and 3.4 and 8.1 mW/cm 2 for macular manipulations using typical settings for 3D and CM groups, respectively. The total retinal light hazard index ranged from 4.31 kJ/m 2 to 17.37 kJ/m 2 for 3D and 11.09 kJ/m 2 to 27.70 kJ/m 2 for CM groups, respectively, whereas the macular hazard index ranged from 2.93 kJ/m 2 to 14.58 kJ/m 2 for 3D and from 6.84 kJ/m 2 to 23.55 kJ/m 2 for CM, respectively ( P < 0.001). One (5%) and 6 (60%) pars plana vitrectomy cases exceeded the threshold limits with 3D and CM groups, respectively ( P < 0.05, chi-square test).
The 3D digitally assisted visualization system offers significantly safer macular surgery compared with the CM, considering the potential retinal hazard.
使用数字三维可视化系统（3D）和传统显微镜（CM）研究黄斑手术期间的视网膜光损伤。
病例对照研究的实验性研究和回顾性评估。
分别有20例和10例患者使用3D和CM进行了玻璃体视网膜前膜的玻璃体切除术。
测量了3D和CM在核心玻璃体切除术和黄斑操作期间使用的代表性设置下的眼内照明器的光谱辐照度。从患者的病历中提取核心玻璃体切除术和黄斑操作所需的时间。根据由标准函数加权的光谱辐照度计算总视网膜光损伤指数和黄斑损伤指数。比较两组之间的总视网膜光损伤指数、黄斑损伤指数以及超过最大允许辐射功率暴露的病例数。
3D组和CM组在核心玻璃体切除术时的光谱辐照度分别为1.6和3.9 mW/cm²，在黄斑操作时分别为3.4和8.1 mW/cm²。3D组的总视网膜光损伤指数范围为4.31 kJ/m²至17.37 kJ/m²，CM组为11.09 kJ/m²至27.70 kJ/m²，而黄斑损伤指数3D组范围为2.93 kJ/m²至14.58 kJ/m²，CM组为6.84 kJ/m²至23.55 kJ/m²（P<0.001）。3D组和CM组分别有1例（5%）和6例（60%）玻璃体切除术病例超过阈值限制（P<0.05，卡方检验）。
考虑到潜在的视网膜损伤，与CM相比，3D数字辅助可视化系统提供了明显更安全的黄斑手术。
