Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
Key Laboratory of Ocular Fundus Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
Graefes Arch Clin Exp Ophthalmol. 2023 Mar;261(3):669-679. doi: 10.1007/s00417-022-05850-z. Epub 2022 Oct 10.
To compare the three-dimensional (3D) heads-up surgery with the traditional microscopic (TM) surgery for various vitreoretinal diseases.
A medical record review of patients that underwent 3D heads-up or TM vitreoretinal surgeries was performed from May 2020 to October 2021 in this retrospective case-control study. Main outcome measures included surgery-related characteristics, efficacy, safety, and satisfaction feedback from the surgical team.
A total of 220 (47.6%) and 242 (52.4%) eyes were included in the 3D and TM groups, respectively. The 3D heads-up system significantly benefits delicate surgical steps, like the epiretinal membrane (ERM) peeling for ERM and internal limiting membrane peeling for idiopathic macular holes (P < 0.05). The 3D heads-up system could facilitate a significantly better visual outcome for pathologic myopic foveoschisis (P = 0.049), while no difference by TM surgery (P = 0.45). For the satisfaction feedback, the 3D heads-up system was rated significantly higher in most subscales and the overall score (P < 0.05). The surgeons' ratings on operating accuracy and the first assistants' rating on operating accuracy and operation cooperation were significantly higher in the TM group than in the 3D group (P < 0.05). Besides that, the 3D heads-up surgery was comparable with TM surgery in the surgery-related characteristics, choice of tamponades, postoperative VA, primary anatomic success, and perioperative complications (P > 0.05).
The efficacy and safety of the 3D heads-up surgery were generally comparable to the TM surgery. The 3D heads-up system could significantly benefit delicate surgical steps and achieve better surgical team satisfaction.
比较 3D 头高脚低位手术与传统显微镜（TM）手术治疗各种玻璃体视网膜疾病的效果。
本回顾性病例对照研究于 2020 年 5 月至 2021 年 10 月对接受 3D 头高脚低位或 TM 玻璃体视网膜手术的患者进行了病历回顾。主要观察指标包括手术相关特征、疗效、安全性和手术团队的满意度反馈。
3D 头高脚低位组和 TM 组分别纳入 220（47.6%）和 242（52.4%）只眼。3D 头高脚低位系统显著有益于精细的手术步骤，如内界膜撕除治疗特发性黄斑裂孔（P<0.05）。3D 头高脚低位系统可以显著改善病理性近视黄斑劈裂（P=0.049）的视力预后，而 TM 手术无差异（P=0.45）。对于满意度反馈，3D 头高脚低位系统在大多数子量表和总体评分上的评分明显更高（P<0.05）。TM 组的手术医生对操作准确性的评分和第一助手对操作准确性和操作配合的评分均明显高于 3D 组（P<0.05）。此外，3D 头高脚低位手术在手术相关特征、眼内填充物的选择、术后 VA、初次解剖成功率和围手术期并发症方面与 TM 手术相当（P>0.05）。
3D 头高脚低位手术的疗效和安全性通常与 TM 手术相当。3D 头高脚低位系统可显著有益于精细的手术步骤，并能提高手术团队的满意度。
