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Introduction
Optical coherence tomography (OCT) is an essential clinical tool in managing ophthalmic diseases by visualizing alterations in the retinal anatomy.1 Integrating OCT into the operating room provides real-time feedback and impacts surgical decision making.2–4 Previous studies examining microscope-integrated intraoperative OCT (iOCT) in anterior and posterior segment surgical cases, including the 3-year results of the DISCOVER study, have demonstrated broad feasibility and surgeon-perceived value in a significant proportion of cases.5
The recent development of digitally enabled vitreo-retinal surgery with three-dimensional (3-D) heads-up display provides a digital stereoscopic view of the surgical field on a high-definition monitor and removes the surgeon from the confinement of the traditional standard operating microscope. As this is an evolving technology, there are limited studies assessing its utility in vitreoretinal surgery.6–9 The 3-D digital surgical platform provides a high degree of stereopsis and an ultra-high-definition view. The ergonomics of a digital visualization system may also offer distinct advantages in reducing fatigue and cervical/lumbar stress for surgeons.6–8,10
The integration of iOCT and digitally enabled vitreoretinal surgery have been described as a new “integrative surgical theater,” although surgeon preference of utility of these two technologies has not been directly compared.11 To better understand the utility of integrating iOCT with digitally-assisted viewing systems, this study compares the surgeon experience between conventional microscope-integrated iOCT and digitally enabled iOCT.
Patients and Methods
This study is an exploratory analysis of the DISCOVER Study, which is a prospective, single-center, multi-surgeon case series. The study was institutional review board-approved, adhered to the tenets of the Declaration of Helsinki, and complied with HIPAA regulations. Written informed consent was obtained from all patients participating in the DISCOVER study. Inclusion criteria included age of 18 years or older, ability to provide informed consent, and planned incisional ophthalmic surgery.
Two comparative groups were included: (1) eyes that had surgery with conventional microscope-integrated iOCT (Rescan 700 Prototype; Carl Zeiss Meditec, Oberkochen, Germany) and (2) eyes that had surgery with a digitally enabled microscope-integrated iOCT (NGENUITY; Alcon, Fort Worth, TX, combined with the same Rescan 700 prototype) (Figure 1). To minimize surgeon-bias influence in feedback, surgeons from the DISCOVER study were only included in this analysis if they had at least one case with the same primary diagnosis in...