Digital 3D heads-up LASIK surgery: feasibility, surgical duration, complication rates, and comparison with a conventional microscope.

PURPOSE: To compare laser-assisted in situ keratomileusis (LASIK) surgery using the NGENUITY 3D visualization system with surgery conducted using the conventional microscope of the Wavelight EX500 excimer laser, by an experienced surgeon (>500 procedures) and a young surgeon (<50 procedures).

SETTING: Single-center 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 was evaluated.

RESULTS: The mean operative time was 1 minute 28 seconds for the experienced surgeon and 2 minutes 3 seconds for the young surgeon ( P < .05). For the experienced surgeon, the mean operative time was 15 seconds longer with the 3D microscope ( P < .05), but this difference disappeared after the 39th operated eye. In the young surgeon's group, no significant difference in operative time was observed between the 3D and conventional systems. 2 cases of intraoperative microerosions (1 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.