Retinal Nerve Fiber Layer Damages from Macular Grasping during Vitrectomy Comparing Traditional and Three-Dimensional Microscope: A Randomized Clinical Trial.

Abstract

Purpose: To analyze the advantages of the new advanced three-dimensional (3D) heads-up microscopy system in vitreoretinal surgery compared to a standard optical microscope, by evaluating postoperative tissue trauma, defined by the extent of swelling of the arcuate nerve fiber layer (SANFL).

Methods: Sixty-four consecutive eyes affected by macular pucker or macular hole underwent macular peeling using a traditional optical microscope (Leica F40) or a 3D heads-up microscopy system (NGENUITY 3D Visualization System). Infrared, blue autofluorescence imaging, and spectral-domain optical coherence tomography (OCT) were performed preoperatively and 2 weeks, 1 month, and 3 months after surgery. The presence of SANFLs was checked postoperatively on infrared and blue autofluorescence fundus imaging, and the extent of each SANFL was measured on OCT near-infrared fundus images.

Results: The presence and the extension of SANFLs were comparable in the two groups (P > 0.05), with a regression over time that was similar in the two groups. The change of the peripapillary retinal nerve fiber layer thickness in the various sectors also appeared to have a similar trend with no statistically significant differences in the two groups (P > 0.05).

Conclusion: NGENUITY system is comparable in terms of visual and anatomical results, offering perspectives for the integration of new advanced visualization technologies.