ABSTRACT Digitally assisted vitreoretinal surgery (DAVS), or three-dimensional (3D) heads-up vitrectomy, replaces conventional microscope eyepieces with a high-dynamic-range camera and a large 3D display, enabling high-magnification surgery with enhanced depth of field, image contrast, and ergonomic benefits for the entire operating team. DAVS allows a substantial reduction in endoillumination while maintaining excellent visualization, which may lower the risk of macular phototoxicity, and supports advanced digital functions, including real-time image processing, color-channel optimization, intraoperative fluorescein angiography, and integrated display of multimodal imaging in a “surgical cockpit.” Comparative studies of macular and rhegmatogenous retinal detachment surgery show that DAVS yields equivalent or shorter operative times, similar anatomical and visual outcomes, fewer dye reinjections, and lower rates of dissociated optic nerve fiber layer changes compared with conventional microscopy. DAVS also offers high-quality surgical recording and an immersive shared 3D view for the entire team, shortening the learning curve for fellows and enhancing intraoperative teaching and remote proctoring. However, limitations include initial learning time, cost, operating room space requirements, and occasional visual discomfort in some users. Overall, DAVS represents a transformative evolution in vitreoretinal surgical visualization, combining improved optical performance, reduced light exposure, and robust digital integration to enhance safety, efficiency, and education in contemporary retinal surgery.
Reddy et al. (Thu,) studied this question.