San Raffaele Performs Surgery with a Fully Digital Augmented Reality Microscope to Treat Macular Hole and Cataract

The surgery was performed on a 66-year-old patient suffering from a macular hole, a retinal condition that can only be treated surgically, and cataract.

A macular hole is a progressive disease that affects the macula, the central area of the retina. The primary symptom is metamorphopsia, which causes distorted vision. In many cases, if diagnosed early, it is possible to stop the disease progression or even improve vision.

Cataract, on the other hand, is a very common eye disease that develops naturally with aging. It is characterized by the clouding of the lens, which prevents light from reaching the retina, leading to vision loss. Cataracts can usually be treated surgically.

The procedure, a minimally invasive vitrectomy combined with cataract surgery, lasted 45 minutes and successfully halted the patient’s visual decline, preventing further progression of the diseases. The patient is doing well and was discharged the day after surgery.

The system used, known as the Beyeonics One® Digital Microscope, is specially designed for ophthalmic surgeons. It is a high-definition digital imaging platform that allows surgeons to:

• View an enlarged and 3D image of the surgical field.
• Access pre-operative and intraoperative information in augmented reality.

This system features a fully digital microscope, eliminating traditional eyepieces, and is connected to a supercomputerthat processes images in real time with zero latency. The images are then transferred to a 4K visor, worn by the surgeons like a "helmet."

The visor, known as an exoscope, is inspired by aircraft pilot technology, where real-time flight information is displayed while they operate the aircraft.

Similarly, surgeons can view the surgical field in high resolution while simultaneously receiving augmented reality information, including:

• Biometric data
• Patient examinations
• Surgical anatomical details

The vision system controls, known as surgical parameters, are adjusted through simple head movements. By slightly tilting their head or raising their chin, surgeons can view pre-operative exams in real-time or adjust lighting settings, such as filters and magnifications.

This technology also enables ocular surgery with infrared lighting, which is invisible to the patient, preventing glare. While the surgeon views the surgical field through digital filters, the patient experiences no discomfort.

The exoscope can be used for all types of ophthalmic surgery, from anterior segment (such as corneal transplants and cataract surgery) to posterior segment (such as vitreoretinal surgery for conditions like retinal detachment, diabetic retinopathy, macular pucker, or macular hole).

This platform provides surgeons with high-resolution, ultra-precise images of the eye, allowing for an ultra-detailed view of the surgical field. Additionally, digital image processing offers two key advantages:

• Enhancing the image with digital filters, improving sharpness and clarity of intraoperative anatomical structures.
• Adding augmented reality details to the surgical image, helping optimize surgery and provide additional crucial information for decision-making.

This technology ensures safer, more precise, and faster surgeries. Patients benefit not only from enhanced surgical performance but also from potentially glare-free procedures, increasing comfort during the operation.

Furthermore, the system offers an immersive educational experience. With interactive real-time guidance from senior surgeons, supported by 3D augmented reality tools, medical trainees can significantly enhance their learning and skill development in a highly realistic environment.

“With the use of this new exoscope, in addition to ergonomic improvements and incredible visual immersion, we can finally integrate all critical clinical and technical information in real-time to refine the surgical process,” said Dr. Lorenzo Iuliano.

“We are thrilled to have access to these cutting-edge technologies. Just as photography, television, and mobile phones have evolved, the time has come for a digital transition in our surgical vision systems.

This exoscope allows us to take a step into the future, enabling more precise surgery while also improving training for new surgeons, ultimately offering our patients the best available technology today,” concluded Dr. Marco Codenotti.