Digital 3d “Heads-Up” Lasik Surgery: Feasibility, Surgical Duration, Complication Rates and Comparison With a Conventional Microscope

PURPOSE: This study aims to compare LASIK surgery using the NGENUITY 3D visualization system (Alcon) with surgery conducted using the conventional microscope of the Wavelight EX500 excimer laser (Alcon), by an experienced surgeon (>500 procedures) and a young surgeon (<50 procedures). SETTINGS: Single centre study at the Rothschild Foundation, Paris, France. DESIGN: Prospective cross-sectional study METHODS: 193 eyes from 99 patients were included: The experienced surgeon operated on 103 eyes (48 with a conventional microscope and 55 with a 3D microscope), while the young surgeon operated on 90 eyes (49 with a conventional microscope and 41 with a 3D microscope). Surgeon-dependent operative time for the excimer laser phase, notable intraoperative events, and complication rates during the first postoperative month were evaluated. RESULTS: The mean operative time was 1 min 28 sec for the experienced surgeon and 2 min 03 sec for the young surgeon (p<0.05). For the experienced surgeon, mean operative time was 15 seconds longer with the 3D microscope (p<0.05), but this difference disappeared after the 39 th operated eye. In the young surgeon’s group, no significant difference in operative time was observed between the 3D and conventional systems. Two cases of intraoperative micro-erosions (one per surgeon, both in the 3D group) were reported, but no postoperative complications were noted. CONCLUSIONS: LASIK surgery using a 3D visualization system is safe and feasible. The learning curve for experienced surgeons is short, and young surgeons do not experience increased difficulty. The 3D system offers significant ergonomic and educational benefits, making it a promising tool for all skill levels.