Comparison Between 3D Heads-Up Display System and Standard Operating Microscope in Diabetic Vitrectomy for Tractional Retinal Detachment.

Abstract

Background: Proliferative diabetic retinopathy (PDR) remains a significant cause of vision loss worldwide, often requiring pars plana vitrectomy (PPV) for tractional retinal detachment (TRD). The introduction of the 3D Heads-Up Display (HUD) system offers ergonomic and visualization advantages.

Methods: This prospective interventional study involved eyes that underwent PPV for TRD. Group A underwent surgery using 3D HUD, while Group B utilised a standard operating microscope (SOM). Outcomes were assessed for surgical time, anatomical success, visual recovery, intraoperative variables, and postoperative complications.

Results: The study included 94 eyes from 90 patients (47 eyes per group). Retinal reattachment was achieved in 100% of cases in both groups at 3 months postoperatively. Mean surgical time was significantly shorter in the 3D HUD group (51.50 ± 24.06 minutes) compared to SOM (67.33 ± 31.27 minutes; p = 0.004). Both groups significantly improved visual acuity, with the 3D HUD showing a superior mean LogMAR BCVA improvement at 3 months. Endoillumination levels were markedly lower with the 3D HUD, reducing the risk of phototoxicity. Surgeons reported greater depth perception, manoeuvrability, and teaching utility with the 3D HUD.

Discussion: In this study, 3D HUD provided anatomical outcomes comparable to SOM while offering shorter surgical times, lower illumination requirements, and favourable visual recovery. These advantages likely stem from enhanced depth perception and improved ergonomics inherent to the 3D system. Overall, our findings support 3D HUD as a safe and efficient alternative for managing complex TRD cases.

Conclusions: The 3D HUD system demonstrated comparable anatomical success, shorter surgical times, enhanced ergonomic benefits, and favourable visual outcomes compared to SOM.