Video-Based Quantification Of Microscope Adjustments In High Myopia Cataract Surgery: A Randomized Controlled Trial Comparing 3D Visualization And Conventional Microscopy
Published 2026 - 44th Congress of the ESCRS
Reference: FP21.02 | Type: Free paper | DOI: 10.82333/xpd9-dk46
Authors: Dr Ching-Wen Huang* 1 , Dr Chieh-Hung Yen 2 , Dr Tzyy-Chang Ho 3
1Department of Ophthalmology,National Taiwan University Hospital,Taipei,Taiwan;Department of Ophthalmology,Fu Jen Catholic University Hospital,New Taipei City,Taiwan, 2Department of Ophthalmology,Chang Gung Memorial Hospital Linkou Branch,Taoyuan,Taiwan;Graduate Institute of Biomedical Engineering,Chang Gung University,Taoyuan,Taiwan, 3Department of Ophthalmology,National Taiwan University Hospital,Taipei,Taiwan;College of Medicine,National Taiwan University,Taipei,Taiwan
Purpose
To evaluate intraoperative microscope adjustment parameters and clinical outcomes of a 3D visualization system versus conventional microscopy in cataract surgery for highly myopic eyes.
Setting
Tertiary referral academic ophthalmology center in Taiwan. All surgeries were performed by an experienced cataract surgeon in a standardized operating room environment using either a three-dimensional (3D) visualization system or a conventional binocular microscope.
Methods
This single-center randomized controlled clinical trial enrolled 40 highly myopic eyes (axial length ≥ 26.0 mm) undergoing phacoemulsification cataract surgery. Eyes were randomized to a 3D visualization system (Alcon NGENUITY®) or a conventional operating microscope. The primary outcome was intraoperative microscope adjustment count. Secondary outcomes included deepest and most superficial focal positions, vertical focal range, cumulative vertical travel distance, operative time, cumulative dissipated energy (CDE), intraoperative complications, postoperative best-corrected visual acuity (BCVA), ΔBCVA, intraocular pressure (IOP), and postoperative complications. Outcomes were assessed at day 1, week 1, month 1, and month 3.
Results
Compared with the non-3D group, the 3D group demonstrated a significantly lower microscope adjustment count (primary outcome), along with a shallower deepest focal position, reduced cumulative vertical travel distance, and a smaller vertical range of focal adjustment (all p < 0.01). Operative time and CDE were comparable between groups. In the non-3D group, intraoperative complications occurred in 2 of 20 eyes (10.0%), both of which were posterior capsule ruptures. In the 3D group, intraoperative complications occurred in 1 of 20 eyes (5.0%), which was an anterior capsule rupture. Postoperative BCVA, ΔBCVA, and IOP at all follow-up visits did not differ significantly between groups.
Conclusions
The 3D visualization system reduced unnecessary microscope lens adjustments and improved intraoperative depth stability without compromising surgical efficiency or postoperative outcomes. Lower rates of posterior capsule rupture and retained lens material were observed in the 3D group. These findings support the use of 3D visualization as a useful adjunct in cataract surgery for highly myopic eyes.