Heads-up for DSAEK

A new three-dimensional (3D) heads-up system for viewing and recording ophthalmic surgery can be helpful when performing endothelial keratoplasty, Yasser Helmy Mohamed MD, PhD told a Cornea Day session at the 21st ESCRS Winter Meeting in Maastricht, The Netherlands. “We are extremely impressed by the accuracy and realism of Sony’s 3D viewing and recording system. The system exhibits virtually no time delay and allows for real-time 3D viewing in the operating room,” said Dr Mohamed, Department of Ophthalmology and Visual Sciences, Nagasaki University, Nagasaki, Japan. In his case report, he described his centre’s first experience of using the heads-up surgery to perform non-Descemet’s stripping automated endothelial keratoplasty (n-DSAEK). In the heads-up approach, the surgeon performs procedures while viewing the microscopic image on a large 3D display sent from a 3D camera, instead of looking through eyepieces of the microscope, Dr Mohamed explained. “Recent advances of 3D cameras and 3D display technology have brought increasing reports of heads-up surgery in the field of ophthalmology. However, previous reports about its use in ophthalmology have focused mostly on cataract and vitreoretinal surgery,” he added. The patient was a 72-year-old male with a history of blunt trauma in the left eye since childhood. In 2004 the patient underwent phacoemulsification and intraocular lens implantation for post-traumatic cataract. In February 2016 the patient was referred to University Ophthalmic’s clinic with post-traumatic bullous keratopathy. The patient presented with uncorrected vision of counting fingers (NC) at 10cm and progressive pain. Slit-lamp examination revealed diffuse stromal and epithelial oedema. In April 2016 the patient underwent n-DSAEK. Dr Mohamed explained that the heads-up system consists of a RESCAN 700 (Zeiss) optical microscope with real-time intraoperative optical coherence tomography (iOCT), a full high-definition medical-grade camera system (PMW-10MD, Sony) and a dual-channel 3D stereoscopic HD digital video recorder with a 42-inch LMD-4251TD monitor (Sony). The surgery was uneventful and performed without any complications, Dr Mohamed said. He noted that the heads-up 3D system and its high magnification made preparation of the eye and handling the flap easier. In addition, iOCT enabled the detection of fluid at the graft-host interface. The only disadvantage of the system was the difficulty in detection of the flap depth within the anterior chamber, which required frequent focus change during the surgery. However, the surgeon did not feel any eye strain or discomfort, Dr Mohamed said. “The implications of 3D recording and display in an educational institution are immense,” he added. Yasser Helmy Mohamed: yasserhelmy@nagasaki-u.ac.jp