Cataract surgery: The journey thus far

Comparison of neck angle and musculoskeletal discomfort of surgeon in cataract surgery between three-dimensional heads-up display system and conventional microscope

The three-dimensional heads-up display system (3D HUDS) is increasingly utilized by ophthalmologists and suggested to offer ergonomic benefits compared to conventional operating microscopes. We aimed to quantitatively assess the surgeon's neck angle and musculoskeletal discomfort during cataract surgery using commercially available 3D HUDS and conventional microscope. In this single-center comparative observational study, the surgeon conducted routine phacoemulsification surgeries using Artevo® 800 and Opmi Lumera® 700 (both from Carl Zeiss Meditec, Jena, Germany). The surgeon's intraoperative neck angle was measured using the Cervical Range of Motion device. Postoperative musculoskeletal discomfort was assessed using the Visual Analog Scale (VAS) score after each surgery. A total of 80 cataract surgeries were analyzed, with 40 using Artevo® 800 and 40 using Opmi Lumera® 700. The neck angle was extended when using Artevo® 800 and flexed when using Opmi Lumera® 700 during continuous curvilinear capsulorhexis (CCC), phacoemulsification, and intraocular lens (IOL) placement (- 8.18 ± 2.85° vs. 8.27 ± 2.93° in CCC, - 7.83 ± 3.30° vs. 8.87 ± 2.83° in phacoemulsification, - 7.43 ± 3.80° vs. 7.67 ± 3.73° in IOL placement, respectively; all p < 0.001). The VAS score was significantly lower in surgeries performed with Artevo® 800 (1.27 ± 0.55 vs. 1.73 ± 0.64, p < 0.001). The findings suggest that 3D HUDS help reduce neck flexion and lower work-related musculoskeletal discomfort through ergonomic improvements.

Cognitive workload, complications and visual outcomes of phacoemulsification cataract surgery: Three-dimensional versus conventional microscope

PURPOSE

To compare the surgical workload, complications, and visual outcomes using the three-dimensional visualization system with the conventional microscope in phacoemulsification cataract surgery.

DESIGN

Prospective, non-randomized, open-label interventional study.

METHODS

All patients underwent phacoemulsification cataract surgery using the three-dimensional visualization system or conventional microscope.

RESULTS

Of the 203 eyes, 80 underwent surgery with the three-dimensional system while 123 underwent with the conventional microscope. No difference was noted in the total surgical duration, complication rates, and visual outcomes between the two groups. However, capsulorhexis was significantly faster using the conventional microscope while posterior chamber intraocular lens insertion was quicker using the three-dimensional system. In terms of cognitive workload comparison, no difference was seen in the surgeons' heart rate, oxygen saturation levels, and surgery task load index total workload score and workload score for all six dimensions of the questionnaire, between the three-dimensional system and conventional microscope groups. As compared to baseline, the heart rate increased significantly during all surgical steps and at the end in both groups. When compared to baseline, the oxygen saturation levels were significantly raised during capsulorhexis, irrigation, and aspiration and posterior chamber intraocular lens insertion and at the end of the surgery in the three-dimensional group and during incision and at the end of the surgery in the conventional microscope group.

CONCLUSIONS

The duration of surgery, complications, and visual acuity outcomes remain unaffected while performing phacoemulsification cataract surgeries with the three-dimensional viewing system when compared to the conventional microscopes. Moreover, the surgeons' cognitive workload too remains unaffected while utilizing this revolutionary three-dimensional surgical technology.

Initial experience with three-dimensional heads-up display system for cataract surgery - A comparative study

Purpose:

To compare the complication rates, surgical time and learning curve using the 3-D Heads up display system in comparison with the conventional microscope for routine cataract surgery.

Methods:

Consecutive consenting adults with uncomplicated cataract were offered phacoemulsification using the 3-D Heads up display system (ARTEVO 800 Carl Zeiss Meditec) or the conventional microscope (Zeiss Lumera 700) by two experienced surgeons. Surgical time, measured from start of corneal incision to removal of microscope from the surgical field and complication rates were compared between the groups.

Results:

Of the 343 eyes enrolled, 100 (29%) underwent surgery using the 3-D Heads up display system. The surgical time for 3-D Heads up display system was significantly higher in the 3-D group (8.4 ± 2.1 vs. 6.5 ± 1.8 minutes, P < 0.001). There were no group differences in surgical complications (2% in 3-D vs. 2.5% in conventional microscope, P = 0.28). Comparing across 4 quartiles within the 3-D group, the mean surgical time was slightly higher during the 1^st quartile (n = 25, 9.1 ± 1.9 minutes) compared to the last quartile (n = 25, 8.2 ± 1.9 minutes) (p = 0.17). Complications in the 3-D group occurred only in the initial 50% of cases. Seven (7%) cases in the 3-D group were converted to conventional binocular microscope of which 3 each were due to difficulty in depth perception and low illumination while one was due to intraoperative pupillary constriction.

Conclusion:

Phacoemulsification with the 3-D Heads up display system takes longer time but offers excellent visualization, ergonomics and safety compared to conventional microscopes. Experienced surgeons should be able to adapt easily after their first 50 surgeries.

Medicinal Plants and Natural Products Used in Cataract Management

Cataract is the leading reason of blindness worldwide and is defined by the presence of any lens opacities or loss of transparency. The most common symptoms of cataract are impaired vision, decreased contrast sensitivity, color disturbance, and glare. Oxidative stress is among the main mechanisms involved in the development of age-related cataract. Surgery through phacoemulsification and intraocular lens implantation is the most effective method for cataract treatment, however, there are chances of serious complications and irreversible loss of vision associated with the surgery. Natural compounds consisting of antioxidant or anti-inflammatory secondary metabolites can serve as potential leads for anticataract agents. In this review, we tried to document medicinal plants and plant-based natural products used for cataract treatment worldwide, which are gathered from available ethnopharmacological/ethnobotanical data. We have extensively explored a number of recognized databases like Scifinder, PubMed, Science Direct, Google Scholar, and Scopus by using keywords and phrases such as “cataract”, “blindness”, “traditional medicine”, “ethnopharmacology”, “ethnobotany”, “herbs”, “medicinal plants”, or other relevant terms, and summarized the plants/phytoconstituents that are evaluated in different models of cataract and also tabulated 44 plants that are traditionally used in cataract in various folklore medical practices. Moreover, we also categorized the plants according to scientific studies carried out in different cataract models with their mechanisms of action.