Personal Experience With 3D Digital Visualization Technology In Cataract Surgery And Corneal Transplantation

To evaluate the clinical utility and intraoperative advantages of a three-dimensional (3D) digital visualization system in cataract surgery and lamellar corneal transplantation, with particular attention to the contribution of digital image filters in improving tissue visualization and surgical precision.

Catholic University of Sacro Cuore - Agostino Gemelli Polyclinic Foundation- IRCCS - Ophthalmic Department

All surgical procedures performed in our unit between 2020 and 2023 were carried out using the 3D digital visualization system NGenuity by the same surgeon (L.M.). Images were captured simultaneously with and without different digital filters during the following surgical steps: endothelial evaluation, capsulorhexis, capsular rupture assessment, cortical removal, viscoelastic removal, corneal suturing, descemetorhexis, graft preparation, graft insertion, and endothelial keratoplasty graft unfolding in the anterior chamber

Particular attention was paid to the qualitative improvement in contrast, edge definition, and depth perception provided by the digital filters, including Green, Monochrome, and Yellow, during different surgical maneuvers.

In cataract surgery, Green and Monochrome filters helps capsulorrhexis in visualization of anterior capsule and edges of posterior capsule ruptures.  Monochrome filter improves contrast, aiding removing cortical material and viscoelastics. In endothelial keratoplasty, Monochrome filter simplifies descemetorhexis highlighting the Descemet layer and improves visualization even in the presence of bleeding. In the DMEK technique, the Green filter enhances the graft during preparation, while the Yellow filter increases contrast of stained graft during unfolding roll in AC. In DALK, the Monochrome and Green filters enhance the visibility of the Descemet–endothelium layer, allowing clearer identification of the extent of accidental perforations

The NGenuity 3D digital system with the use of dedicated digital filters enhances tissue contrast and improves identification of critical surgical planes during both cataract surgery and corneal transplantation. These advantages are particularly relevant in complex cases with reduced intraoperative visibility. Moreover, the system offers significant educational benefits by providing high-quality shared visualization of surgical steps. Further prospective studies are warranted to quantify its impact on surgical outcomes and complication rates. Overall, the 3D system provided excellent depth perception, improved ergonomics for the surgeon, and the possibility of shared visualization with the surgical team and trainees.