感染性眼内炎に対する3次元デジタル可視化システム支援下の硝子体切除術

To compare the surgical outcomes and assess the effectiveness of a three-dimensional digital visualization system (3DVS) versus traditional microscope-assisted pars plana vitrectomy in the management of infectious endophthalmitis.

A retrospective case series study was conducted on 29 patients diagnosed with infectious endophthalmitis who underwent 23-gauge transconjunctival vitrectomy between 1 Jan. 2020 and 31 Aug. 2023. Of all these patients, 16 cases underwent vitrectomy-assisted by the 3DVS (3D group), and the other 13 cases by traditional microscope (eyepiece group). The main comparison focuses on the differences between the two systems in terms of operation time, the brightness of the endoillumination, complications, and preoperative and final best-corrected visual acuity (BCVA, logMAR).

There were no significant differences in baseline characteristics between the two groups, with trauma being the most prevalent cause of infection (10 vs 8). The positive detection rate of pathogenic bacteria exceeded 40% in both groups (43.75% vs. 46.15%). The results showed that the incidence of complications, including high intraocular pressure (3 vs. 4) and retinal detachment (4 vs. 3), did not differ significantly between the groups (chi-square = 0.2857, p = 0.5930). The mean operation time was slightly shorter in the 3D group (75.94 ± 25.70 min) compared to the eyepiece group (82.31 ± 25.38 min, p = 0.5102). However, the 3D group exhibited significantly lower endoillumination (25%-35%) than the eyepiece group (40%-50%, p < 0.0001). Both groups demonstrated significant improvement in BCVA at the end of follow-up (p = 0.0006, t = 4.321). The mean final BCVA for the 3D group was 1.373 ± 0.9824 logMAR, which was modestly superior to the eyepiece group's mean of 1.805 ± 0.9549 logMAR.

The 3DVS provides comparable surgical outcomes to the traditional microscope, with the advantages of clearer intraoperative visualization, lower required illumination, and optimized ergonomic design. It is suitable for complex and prolonged endophthalmitis surgery, offering excellent safety and efficacy.