An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery
Purpose To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method...
Gespeichert in:
| Veröffentlicht in: | Graefe's archive for clinical and experimental ophthalmology 2019-03, Vol.257 (3), p.473-483 |
|---|---|
| Hauptverfasser: | , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 483 |
|---|---|
| container_issue | 3 |
| container_start_page | 473 |
| container_title | Graefe's archive for clinical and experimental ophthalmology |
| container_volume | 257 |
| creator | Palácios, Renato Menezes de Carvalho, André Corrêa Maia Maia, Maurício Caiado, Rafael Ramos Camilo, Danilo Aedo Gardim Farah, Michel Eid |
| description | Purpose
To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method in porcine eyes. For full-thickness idiopathic macular holes (MHs), we analyzed the times required for pars plana vitrectomy (PPV) and internal limiting membrane (ILM) rhexis by using traditional microscopy and 3D system, and to evaluate anatomical surgical results.
Methods
During experimental vitreoretinal surgery on porcine eyes, two retinal surgeons applied the heads-up method. In clinical surgery, 14 retinal surgeons performed almost all types of vitreoretinal surgeries in association with facectomy, Ahmed glaucoma valve implant, or minimally invasive glaucoma surgery using an iStent®. The Ngenuity® 3D Visualization System was digitally integrated with intraoperative optical coherence tomography, the Verion™ Image-Guided System, and an endoscope (with a modified GoPro® camera). To compare the 3D system with traditional microscopy, ergonomics, educational value, image sharpness, depth perception, field of view, advantages and disadvantages, and technical feasibility were assessed using a questionnaire. One year later, the 14 surgeons answered the same questionnaire again, in order to assess whether they became more comfortable or not with 3D. For treating MHs, four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3D visualization). The completion time for PPV and ILM rhexis were determined by using both methods.
Results
In porcine eyes, disabling the color channels allowed better visualization of the ILM, either with Brilliant Blue G (BBG), indocyanine green chorioangiography (ICG), or açai dye; transillumination through the sclera was also better without a color channel, but visualization of the peripheral vitreous was better with a blue channel. Regarding clinical experience, the questionnaire responses showed that the respondents generally favored the heads-up method compared with traditional microscopy (
p
|
| doi_str_mv | 10.1007/s00417-019-04246-w |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179385716</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2179385716</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-ee3d64736a8b626588af38f2bec9553783b33a9fb3421c1e9b71cba3262af82b3</originalsourceid><addsrcrecordid>eNp9kUGPFCEQhYnRuLOrf8CDIfHiBQWqge7jutHVZBMvmuyN0HS1w6aHHoF2HH-9jL1q4sET4fG9V6EeIc8EfyU4N68z540wjIuO8UY2mh0ekI1oQDHD5e1DsuFGCtaCvD0j5znf8cqDEo_JGXDdKN2pDTlcRorf95jCDmNxE3VxoH4KMfh6yWUZjnSOtGyRVq2EKq44Ro-ZziN9k9yPMAUX6bdQEs4JS4gn75K-4BwzPYSypVt0Q2bLfpXT8Ql5NLop49P784J8fvf209V7dvPx-sPV5Q3zYFRhiDDoxoB2ba-lVm3rRmhH2aPvlALTQg_gurGHRgovsOuN8L0DqaUbW9nDBXm55u7T_HXBXOwuZI_T5CLOS7ZSmA5aZYSu6It_0Lt5SfUrJ0pXoqtYpeRK-TTnnHC0-7o7l45WcHuqxa612FqL_VWLPVTT8_vopd_h8Mfyu4cKwArk-hTrgv7O_k_sT5SCmqc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2167169571</pqid></control><display><type>article</type><title>An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery</title><source>SpringerNature Journals</source><creator>Palácios, Renato Menezes ; de Carvalho, André Corrêa Maia ; Maia, Maurício ; Caiado, Rafael Ramos ; Camilo, Danilo Aedo Gardim ; Farah, Michel Eid</creator><creatorcontrib>Palácios, Renato Menezes ; de Carvalho, André Corrêa Maia ; Maia, Maurício ; Caiado, Rafael Ramos ; Camilo, Danilo Aedo Gardim ; Farah, Michel Eid</creatorcontrib><description>Purpose
To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method in porcine eyes. For full-thickness idiopathic macular holes (MHs), we analyzed the times required for pars plana vitrectomy (PPV) and internal limiting membrane (ILM) rhexis by using traditional microscopy and 3D system, and to evaluate anatomical surgical results.
Methods
During experimental vitreoretinal surgery on porcine eyes, two retinal surgeons applied the heads-up method. In clinical surgery, 14 retinal surgeons performed almost all types of vitreoretinal surgeries in association with facectomy, Ahmed glaucoma valve implant, or minimally invasive glaucoma surgery using an iStent®. The Ngenuity® 3D Visualization System was digitally integrated with intraoperative optical coherence tomography, the Verion™ Image-Guided System, and an endoscope (with a modified GoPro® camera). To compare the 3D system with traditional microscopy, ergonomics, educational value, image sharpness, depth perception, field of view, advantages and disadvantages, and technical feasibility were assessed using a questionnaire. One year later, the 14 surgeons answered the same questionnaire again, in order to assess whether they became more comfortable or not with 3D. For treating MHs, four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3D visualization). The completion time for PPV and ILM rhexis were determined by using both methods.
Results
In porcine eyes, disabling the color channels allowed better visualization of the ILM, either with Brilliant Blue G (BBG), indocyanine green chorioangiography (ICG), or açai dye; transillumination through the sclera was also better without a color channel, but visualization of the peripheral vitreous was better with a blue channel. Regarding clinical experience, the questionnaire responses showed that the respondents generally favored the heads-up method compared with traditional microscopy (
p
< 0.05); however, despite a slightly higher average score, the 3D system was not statistically significantly preferred in terms of technical feasibility (
p
= 0.1814). Answering again the same questionnaire 1 year later, the 14 surgeons felt more comfortable with 3D (
p
< 0.05). The type of surgery benefitting most from the 3D system was peeling of the ILM or epiretinal membrane (
p
< 0.001), and that receiving the least benefit was anterior segment surgery (
p
< 0.001). In addition, surgeons did not report benefits of color channels, preferring to disable it (
p
< 0.001). Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery.
Conclusions
The 3D system was preferred to traditional microscopy. The 3D system was especially helpful for certain specific types of surgeries and served as an educational tool, having reduced illumination and allowing precise focusing. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. As a digital platform, it will be amenable to constant upgrades and may ultimately become the new standard for ophthalmic surgery.</description><identifier>ISSN: 0721-832X</identifier><identifier>EISSN: 1435-702X</identifier><identifier>DOI: 10.1007/s00417-019-04246-w</identifier><identifier>PMID: 30645695</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Basic Science ; Color vision ; Depth perception ; Endoscopes ; Eye ; Eye surgery ; Glaucoma ; Head ; Medicine ; Medicine & Public Health ; Methods ; Microscopy ; Ophthalmology ; Questionnaires ; Retina ; Surgeons ; Surgery ; Visualization</subject><ispartof>Graefe's archive for clinical and experimental ophthalmology, 2019-03, Vol.257 (3), p.473-483</ispartof><rights>Springer-Verlag GmbH Germany, part of Springer Nature 2019</rights><rights>Graefe's Archive for Clinical and Experimental Ophthalmology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-ee3d64736a8b626588af38f2bec9553783b33a9fb3421c1e9b71cba3262af82b3</citedby><cites>FETCH-LOGICAL-c375t-ee3d64736a8b626588af38f2bec9553783b33a9fb3421c1e9b71cba3262af82b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00417-019-04246-w$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00417-019-04246-w$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30645695$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Palácios, Renato Menezes</creatorcontrib><creatorcontrib>de Carvalho, André Corrêa Maia</creatorcontrib><creatorcontrib>Maia, Maurício</creatorcontrib><creatorcontrib>Caiado, Rafael Ramos</creatorcontrib><creatorcontrib>Camilo, Danilo Aedo Gardim</creatorcontrib><creatorcontrib>Farah, Michel Eid</creatorcontrib><title>An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery</title><title>Graefe's archive for clinical and experimental ophthalmology</title><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><description>Purpose
To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method in porcine eyes. For full-thickness idiopathic macular holes (MHs), we analyzed the times required for pars plana vitrectomy (PPV) and internal limiting membrane (ILM) rhexis by using traditional microscopy and 3D system, and to evaluate anatomical surgical results.
Methods
During experimental vitreoretinal surgery on porcine eyes, two retinal surgeons applied the heads-up method. In clinical surgery, 14 retinal surgeons performed almost all types of vitreoretinal surgeries in association with facectomy, Ahmed glaucoma valve implant, or minimally invasive glaucoma surgery using an iStent®. The Ngenuity® 3D Visualization System was digitally integrated with intraoperative optical coherence tomography, the Verion™ Image-Guided System, and an endoscope (with a modified GoPro® camera). To compare the 3D system with traditional microscopy, ergonomics, educational value, image sharpness, depth perception, field of view, advantages and disadvantages, and technical feasibility were assessed using a questionnaire. One year later, the 14 surgeons answered the same questionnaire again, in order to assess whether they became more comfortable or not with 3D. For treating MHs, four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3D visualization). The completion time for PPV and ILM rhexis were determined by using both methods.
Results
In porcine eyes, disabling the color channels allowed better visualization of the ILM, either with Brilliant Blue G (BBG), indocyanine green chorioangiography (ICG), or açai dye; transillumination through the sclera was also better without a color channel, but visualization of the peripheral vitreous was better with a blue channel. Regarding clinical experience, the questionnaire responses showed that the respondents generally favored the heads-up method compared with traditional microscopy (
p
< 0.05); however, despite a slightly higher average score, the 3D system was not statistically significantly preferred in terms of technical feasibility (
p
= 0.1814). Answering again the same questionnaire 1 year later, the 14 surgeons felt more comfortable with 3D (
p
< 0.05). The type of surgery benefitting most from the 3D system was peeling of the ILM or epiretinal membrane (
p
< 0.001), and that receiving the least benefit was anterior segment surgery (
p
< 0.001). In addition, surgeons did not report benefits of color channels, preferring to disable it (
p
< 0.001). Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery.
Conclusions
The 3D system was preferred to traditional microscopy. The 3D system was especially helpful for certain specific types of surgeries and served as an educational tool, having reduced illumination and allowing precise focusing. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. As a digital platform, it will be amenable to constant upgrades and may ultimately become the new standard for ophthalmic surgery.</description><subject>Basic Science</subject><subject>Color vision</subject><subject>Depth perception</subject><subject>Endoscopes</subject><subject>Eye</subject><subject>Eye surgery</subject><subject>Glaucoma</subject><subject>Head</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Methods</subject><subject>Microscopy</subject><subject>Ophthalmology</subject><subject>Questionnaires</subject><subject>Retina</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Visualization</subject><issn>0721-832X</issn><issn>1435-702X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kUGPFCEQhYnRuLOrf8CDIfHiBQWqge7jutHVZBMvmuyN0HS1w6aHHoF2HH-9jL1q4sET4fG9V6EeIc8EfyU4N68z540wjIuO8UY2mh0ekI1oQDHD5e1DsuFGCtaCvD0j5znf8cqDEo_JGXDdKN2pDTlcRorf95jCDmNxE3VxoH4KMfh6yWUZjnSOtGyRVq2EKq44Ro-ZziN9k9yPMAUX6bdQEs4JS4gn75K-4BwzPYSypVt0Q2bLfpXT8Ql5NLop49P784J8fvf209V7dvPx-sPV5Q3zYFRhiDDoxoB2ba-lVm3rRmhH2aPvlALTQg_gurGHRgovsOuN8L0DqaUbW9nDBXm55u7T_HXBXOwuZI_T5CLOS7ZSmA5aZYSu6It_0Lt5SfUrJ0pXoqtYpeRK-TTnnHC0-7o7l45WcHuqxa612FqL_VWLPVTT8_vopd_h8Mfyu4cKwArk-hTrgv7O_k_sT5SCmqc</recordid><startdate>20190301</startdate><enddate>20190301</enddate><creator>Palácios, Renato Menezes</creator><creator>de Carvalho, André Corrêa Maia</creator><creator>Maia, Maurício</creator><creator>Caiado, Rafael Ramos</creator><creator>Camilo, Danilo Aedo Gardim</creator><creator>Farah, Michel Eid</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20190301</creationdate><title>An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery</title><author>Palácios, Renato Menezes ; de Carvalho, André Corrêa Maia ; Maia, Maurício ; Caiado, Rafael Ramos ; Camilo, Danilo Aedo Gardim ; Farah, Michel Eid</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-ee3d64736a8b626588af38f2bec9553783b33a9fb3421c1e9b71cba3262af82b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Basic Science</topic><topic>Color vision</topic><topic>Depth perception</topic><topic>Endoscopes</topic><topic>Eye</topic><topic>Eye surgery</topic><topic>Glaucoma</topic><topic>Head</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Methods</topic><topic>Microscopy</topic><topic>Ophthalmology</topic><topic>Questionnaires</topic><topic>Retina</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Visualization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Palácios, Renato Menezes</creatorcontrib><creatorcontrib>de Carvalho, André Corrêa Maia</creatorcontrib><creatorcontrib>Maia, Maurício</creatorcontrib><creatorcontrib>Caiado, Rafael Ramos</creatorcontrib><creatorcontrib>Camilo, Danilo Aedo Gardim</creatorcontrib><creatorcontrib>Farah, Michel Eid</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Neurosciences Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Palácios, Renato Menezes</au><au>de Carvalho, André Corrêa Maia</au><au>Maia, Maurício</au><au>Caiado, Rafael Ramos</au><au>Camilo, Danilo Aedo Gardim</au><au>Farah, Michel Eid</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery</atitle><jtitle>Graefe's archive for clinical and experimental ophthalmology</jtitle><stitle>Graefes Arch Clin Exp Ophthalmol</stitle><addtitle>Graefes Arch Clin Exp Ophthalmol</addtitle><date>2019-03-01</date><risdate>2019</risdate><volume>257</volume><issue>3</issue><spage>473</spage><epage>483</epage><pages>473-483</pages><issn>0721-832X</issn><eissn>1435-702X</eissn><abstract>Purpose
To evaluate the initial experiences of several vitreoretinal surgeons in Brazil, both experienced and beginners, with a three-dimensional (3D) system, and to report the advantages and disadvantages of this technology. We also report surgical manipulations performed using the heads-up method in porcine eyes. For full-thickness idiopathic macular holes (MHs), we analyzed the times required for pars plana vitrectomy (PPV) and internal limiting membrane (ILM) rhexis by using traditional microscopy and 3D system, and to evaluate anatomical surgical results.
Methods
During experimental vitreoretinal surgery on porcine eyes, two retinal surgeons applied the heads-up method. In clinical surgery, 14 retinal surgeons performed almost all types of vitreoretinal surgeries in association with facectomy, Ahmed glaucoma valve implant, or minimally invasive glaucoma surgery using an iStent®. The Ngenuity® 3D Visualization System was digitally integrated with intraoperative optical coherence tomography, the Verion™ Image-Guided System, and an endoscope (with a modified GoPro® camera). To compare the 3D system with traditional microscopy, ergonomics, educational value, image sharpness, depth perception, field of view, advantages and disadvantages, and technical feasibility were assessed using a questionnaire. One year later, the 14 surgeons answered the same questionnaire again, in order to assess whether they became more comfortable or not with 3D. For treating MHs, four surgeons (surgeon 1, fellows 1, 2, 3) performed the total of 40 surgeries. Each one performed 10 surgeries (5 with traditional microscopy and 5 with 3D visualization). The completion time for PPV and ILM rhexis were determined by using both methods.
Results
In porcine eyes, disabling the color channels allowed better visualization of the ILM, either with Brilliant Blue G (BBG), indocyanine green chorioangiography (ICG), or açai dye; transillumination through the sclera was also better without a color channel, but visualization of the peripheral vitreous was better with a blue channel. Regarding clinical experience, the questionnaire responses showed that the respondents generally favored the heads-up method compared with traditional microscopy (
p
< 0.05); however, despite a slightly higher average score, the 3D system was not statistically significantly preferred in terms of technical feasibility (
p
= 0.1814). Answering again the same questionnaire 1 year later, the 14 surgeons felt more comfortable with 3D (
p
< 0.05). The type of surgery benefitting most from the 3D system was peeling of the ILM or epiretinal membrane (
p
< 0.001), and that receiving the least benefit was anterior segment surgery (
p
< 0.001). In addition, surgeons did not report benefits of color channels, preferring to disable it (
p
< 0.001). Comparisons between the average time for full PPV and ILM rhexis by using the two methods were non-significant, neither in each individual case of 3D surgery for each surgeon. Surgeon 1 had always been faster than his fellows. Thirty-six (90%) full-thickness MHs were successfully closed with one surgery.
Conclusions
The 3D system was preferred to traditional microscopy. The 3D system was especially helpful for certain specific types of surgeries and served as an educational tool, having reduced illumination and allowing precise focusing. Concerning MH surgery, heads-up method was similar to traditional microscopy regarding length of time and anatomical surgical results. As a digital platform, it will be amenable to constant upgrades and may ultimately become the new standard for ophthalmic surgery.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>30645695</pmid><doi>10.1007/s00417-019-04246-w</doi><tpages>11</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0721-832X |
| ispartof | Graefe's archive for clinical and experimental ophthalmology, 2019-03, Vol.257 (3), p.473-483 |
| issn | 0721-832X 1435-702X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2179385716 |
| source | SpringerNature Journals |
| subjects | Basic Science Color vision Depth perception Endoscopes Eye Eye surgery Glaucoma Head Medicine Medicine & Public Health Methods Microscopy Ophthalmology Questionnaires Retina Surgeons Surgery Visualization |
| title | An experimental and clinical study on the initial experiences of Brazilian vitreoretinal surgeons with heads-up surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-19T03%3A19%3A48IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=An%20experimental%20and%20clinical%20study%20on%20the%20initial%20experiences%20of%20Brazilian%20vitreoretinal%20surgeons%20with%20heads-up%20surgery&rft.jtitle=Graefe's%20archive%20for%20clinical%20and%20experimental%20ophthalmology&rft.au=Pal%C3%A1cios,%20Renato%20Menezes&rft.date=2019-03-01&rft.volume=257&rft.issue=3&rft.spage=473&rft.epage=483&rft.pages=473-483&rft.issn=0721-832X&rft.eissn=1435-702X&rft_id=info:doi/10.1007/s00417-019-04246-w&rft_dat=%3Cproquest_cross%3E2179385716%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2167169571&rft_id=info:pmid/30645695&rfr_iscdi=true |