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 Table of Contents  
INSTRUMENT CORNER
Year : 2019  |  Volume : 31  |  Issue : 2  |  Page : 161-163

3D - digitally assisted ocular surgery


Department of Vitreo-Retina, Sarakshi Netralaya, Nagpur, Maharashtra, India

Date of Web Publication27-Aug-2019

Correspondence Address:
Dr. Prashant K Bawankule
Sarakshi Netralaya, 19, Rajiv Nagar, Wardha Road, Nagpur - 440 025, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/kjo.kjo_44_19

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How to cite this article:
Bawankule PK, Narnaware SH. 3D - digitally assisted ocular surgery. Kerala J Ophthalmol 2019;31:161-3

How to cite this URL:
Bawankule PK, Narnaware SH. 3D - digitally assisted ocular surgery. Kerala J Ophthalmol [serial online] 2019 [cited 2019 Nov 12];31:161-3. Available from: http://www.kjophthal.com/text.asp?2019/31/2/161/265502




  Science is Change and Change is Science Top


Lot of changes have happened in various surgical techniques and equipment. Cataract surgery has evolved from intracapsular cataract extraction to extracapsular cataract extraction to phacoemulsification. Phacoemulsification has also seen changes from longitudinal to torsional and now to Turbo. So also, the vitreous surgery has moved from 18G, 600 cuts/minute to now 27G, 18,000 cuts/minute.

However, in the last five decades, the visualization has been only with microscope which is based on Galilean's Telescope Optical Principle, which is as old as 300 years old.

Digitalization of various imaging and diagnostics has revolutionized the evolution of fundus fluorescein angiography (FFA), indocyanine green, optical coherence tomography (OCT), and OCT angiography, leading to better quality of images and understanding of disease process. The reproducibility on sequential follow-ups further helped us in understanding the course of the disease. The long-awaited digitalized operating viewing system has finally stepped into our theaters in the form of NGENUITY®.


  Ngenuity Top


The NGENUITY permits a digitally assisted ocular surgery which provides a three-dimensional (3D) view.

The real-time viewing and operating experience is now possible because of the reduction of time lag to <0.70 ms which is little more than the human perceptible limits, i.e., 0.50 ms.

The digitalization of the image permits excellent resolution, image depth, clarity, and color contrast.


  Know the System Top


It consists of a 3D stereoscopic camera [Figure 1] (ICM™-5 3D high-dynamic range) which is placed in the place of eyepieces in our microscope. The image captured by this goes to the central processing unit (CPU) [Figure 2]a which is the heart of the machine. The processed image is transmitted, relayed, and displayed on a 55” 3D high-definition 4K organic light-emitting diode flat screen.
Figure 1: System with camera and screen

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Figure 2: (a) CPU (b) polarized glasses

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The image has to be visualized with passive polarized 3D glasses [Figure 2]b.


  Advantages of Digitalization Top


  1. Magnification – The basic magnification of the NGENUITY is 30% more than the maximum magnification of an analog microscope. More magnification means better resolution and better resolution means precision. Unlike the analog microscope, the magnification of the proposed system does not compromise the depth and field of view
  2. Field of view – Peripheral acuity is inversely proportional to magnification, leading to blurring of peripheral field in our microscopes [Figure 3]. The digitalization allows correction of peripheral blur [Figure 4] associated with higher magnification, thereby permitting viewing of the area beyond the area of action and thereby reducing associated secondary complications
  3. Depth – Depth of field is inversely proportional to magnification in conventional microscopes. Therefore, steps warranting higher magnification like macular peel are compromised by the depth, forcing a surgeon to go for a lower magnification as a compromise. Digitalization in NGENUITY permits the depth without compromising the magnification [Figure 5]
  4. Light and contrast balance – The image acquired in our digital cameras can be altered for contrast, color, and brightness. So also, the image acquired by NGENUITY is altered on various parameters before it is relayed onto the screen by CPU, to give a better quality picture and thereby permitting enhanced visual experience
  5. Illumination – The digital technology of NGENUITY has very high light sensitivity allowing surgery to be conducted at photon streams 5–10 times lower than that in standard microscope
  6. Filters – The machine has the following three filters, thereby permitting better visualization of structure during virtual reality procedures
  7. Figure 3: Field of view with microscope

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    Figure 4: Field of view with N-Genuity

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    Figure 5: Depth and magnification with N-Genuity

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    • Red-free filter: For vitreous hemorrhage
    • Yellow-free filter: For macular procedures
    • Blue-free filter: For internal limiting membrane peeling


  8. Surgical ergonomics – 85% of high-volume surgeons complain of neck and back pain By age 55, over 70% of ophthalmologists have neck, back, or shoulder injuries. The heads-up surgery is a respite for the surgeons, thereby permitting a longer surgical life plan
  9. Expanded surgical view – The panoramic operating view [Figure 6] is visible to all in the personnel's operation theater.
  10. Figure 6: Panoramic Surgical view

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    Key benefits:

    • Efficiency is increased because nurses, scrub technician, and anesthesiologists are engaged
    • Teaching is improved because everyone can see what the surgeon sees


  11. Data fusion: The platform is designed for integrating future updates such as:


    • Surgical parameters of phacoemulsification/vitrectomy machines
    • Intraoperative OCT images
    • HER data OCT, digital fundus images, and digitized retinal drawings


  12. Capturing surgical videos: True edit, the software used in machine is the best software for recording videos.



  Conclusion Top


Digitalization allows the surgeon to work under the highest magnification without compromising on field and depth with less chances of iatrogenic phototoxicity and higher precision. Therefore, digitally assisted surgery is the future of operating viewing system.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.




    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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