[Concepts and clinical application of digital 3D microscopy]

Heads-up 3D surgery is becoming increasingly more important in ophthalmic microsurgery. Digital 3D visualization systems supplement traditional binocular microscopes by high-resolution monitor presentations and enable improved depth perception, ergonomics, team communication and teaching.

This review aims to summarize the development, current evidence, technical features, advantages, and limitations of heads-up 3D surgery in routine clinical ophthalmology.

This article provides a narrative review of clinical studies, case series, systematic reviews and meta-analyses evaluating the application of 3D visualization systems in cataract, vitreoretinal, corneal and glaucoma surgery. Ergonomic, educational and technological aspects were additionally assessed.

The available evidence demonstrates comparable safety and effectiveness of heads-up 3D surgery and conventional microscopy for cataract and vitreoretinal procedures, without increased complication rates. Enhanced depth of field, digital color and contrast filters as well as the possibility of reduced intensity of illumination improve the visualization of delicate structures and support precise surgical maneuvers with reduced light exposure. The integration of intraoperative imaging facilitates real-time decision-making. In addition, consistent ergonomic advantages and clear educational benefits for ophthalmic surgeons are reported. Future advances in the fields of augmented reality, artificial intelligence and telemedicine are expected to further expand the clinical and educational role of heads-up 3D systems.