Three-Dimensional Heads-Up Display Vitrectomy and Intraoperative Optical Coherence Tomography

Since 1946, when the microscope was first used in ophthalmic surgery, and through the development of pars plana vitrectomy in the 1970s, modern vitreoretinal surgery has seen tremendous advances in techniques (such as small-gauge systems and wound construction), in the development of instruments (such as endo-illumination, high-speed vitreous cutters, and fluidic improvements), and in visualization systems, with particular emphasis on Three-Dimensional Heads-Up Display (3D-HUD) vitrectomy and the use of intraoperative OCT. The primary benefits of 3D-HUD display systems include improved ergonomics, the need for lower levels of illumination, greater interaction between the surgeon and observers, which enhances teaching in academic settings, and an expanded field of view with the possibility of greater image magnification. An important advancement associated with 3D-HUD is the use of intraoperative OCT (i-OCT), which provides real-time OCT images of the macula and posterior pole during surgery. In vitreoretinal surgery, the greatest utility of i-OCT is in diseases of the vitreoretinal interface, improving visualization of structures such as the internal limiting membrane, epirretinal membrane, and residual traction, and aiding in the localization of cleavage planes. These technologies are continuously evolving with the common goal of making vitreoretinal surgery safer and yielding better outcomes.