Digital 3D "Heads-up" Cataract Surgery: Safety Profile and Comparison with the Conventional Microscope System

The aim of this study was to compare the complication rates between surgery performed using digital heads-up 3D system (3D group) and a conventional binocular microscope-based system (BM group) in a large series of cataract operations performed by the same surgeon.

This retrospective analysis included a consecutive series of 2,000 cataract operations. The 3D group included n = 1,000 operations performed immediately following the introduction of a 3D system (Alcon Ngenuity). For comparison, the last n = 1,000 operations performed with a binocular microscope were included in the BM group. The 3D system was adapted to the existing microscope so that the microscope optics remained unchanged. The In both groups, the surgical techniques used were either phacoemulsification or femtosecond laser cataract surgery. Complications were recorded and analyzed retrospectively.

The proportion of femto-laser cataract operations was 19.8% in the 3D group and 18.6% in the BM group. Capsule rupture occurred in 10 eyes (3D: n = 4 (0.4%), anterior vitrectomy: n = 2, pars plana vitrectomy: n = 1; BM: n = 6 cases (0.6%), anterior vitrectomy: n = 4, pars plana vitrectomy: n = 1). A short-term iris prolapse occurred in 3 eyes (3D: n = 2, BM: n = 1). Zonulolysis occurred in 2 eyes (3D: n = 1, BM: n = 1). Overall, there was no statistically significant difference between the two groups (p > 0.5). There was no significant increase in the duration of surgery following the switch to the 3D technique.

In a large series of 2000 eyes, there was no significant difference between 3D and BM surgery in terms of the safety profile during cataract surgery. 3D surgery can, therefore, be used for cataract operations without additional risk.