Magnification and Refocusing Comparison in Cataract Surgery Using a Heads-Up Three-Dimensional Visualization System versus Conventional Binocular Microscopy

PURPOSE: To compare magnification and refocusing during phacoemulsification with the NGENUITY(®) 3-D Visualization System (3-D) versus the conventional microscope (CM) OPMI LUMERA 700. SETTING: This study was performed in the Department of Anterior Segment of the Fundación Hospital Nuestra Señora de la Luz. DESIGN: Prospective, randomized, cross-sectional, multi-surgeon, and comparative study. METHODS: This study enrolled 100 patients (eyes) scheduled for phacoemulsification to measure the number of times changes in focusing and magnification were needed during cataract surgery. RESULTS: Our study included 100 patients. From the endpoints evaluated, “zoom-in” showed statistically significant differences for all of the four predefined cataract surgery steps (means: Step 1, 0.38 (CM) vs 0.08 (3-D); Step 2, 0.36 (CM) vs 0.06 (3-D); Step 3, 0.54 (CM) vs 0.22 (3-D); Step 4, 0.56 (CM) vs 0.24 (3-D); all comparisons, p <0.05). In Step 4, there was a statistically significant increased use of “focus-out” for the 3-D system (mean 0.16 (CM) vs 0.58 (3-D); p <0.05). “Focus-in” and “zoom-out” showed no group differences for all steps. The duration of surgery with the 3-D system was longer at each step and overall. The percentage of light intensity did not show a statistically significant difference between both systems, with a mean of 99.45 for CM vs 98.43% for the heads-up system. CONCLUSION: The heads-up 3-D system is a safe option that offers excellent magnification for anterior segment visualization. The surgical time is longer, but adjusting settings like light intensity and brightness may facilitate some surgical steps early in the learning curve.