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3D-Videoscopy during Ophthalmosurgical Procedures: Future Transition from Microscope towards Monitor?

1Gerding H., 2Kolck A., 3Taneri S.,
1Westfälische Wilhelms-Universität Münster, Augenklinik (Münster)
2 (Münster)
3Harvard Medical School, Ophthalmology Department (Boston)

Background: Thus far the use of technical systems providing 3D-projection during ophthalmosurgical interventions is not established as a routine option due to the uncomfortable design (video helmets, shutter frames) or optical disadvantages (polarized projection). In this study a newly developed true 3D stereo monitor (D4D® type of Dresden3D®) that can be used in free sight mode without any disabling technical equipment (glasses, frames etc.) was tested clinically.
Methods: The surgical testing unit was equipped with: OPMI CS surgical microscope (Zeiss) with double beam splitter, video adapters (F 85 Zeiss), two 3CCD digital video cameras (ZEP 925, Zeiss) and the D4D® 3D-display of Dresden3D including image processor, eye tracking system and stereo video recording. This setting was applied during 9 complex procedures including anterior and posterior segment surgical manipulations.
Results: First clinical testing procedures clearly provided evidence that even precise and critical surgical maneuvers could be safely performed solely by visualizing the surgical field with the stereo monitor. The transition towards monitor guided surgery was possible as an immediate step without any period of training. The wide field stereoscopic monitor view (up to 40° horizontal field) was providing a very plastic projection with high stereoscopic resolution. Due to the high sensitivity of video cameras used it was possible to display stereoscopic images from the fundus at light intensities below the threshold of visualization with a standard surgical microscope.
Conclusions: So far the systems proved to be a feasible option for the future design of ergonomically designed working units for ophthalmic surgery. It can serve as a potential expansion or even substitute of conventional stereo microscopes used for anterior and posterior segment surgery. Further options are: 3D-guided telemedical interventions, 3D-recording for surgical post procedure quality control, training and teaching purposes.