An Impossible Viewpoint
One might argue that the operating microscope is all that is required for monitoring vitreo-retinal surgery. However, the benefits of endoscopy are most apparent when anterior segment conditions do not permit a posterior view or when attempting to target anatomy that is difficult or impossible to see, even under optimal conditions. Specifically, the locations of the peripheral retina, pars plana, ciliary bodies, the sulcus, and posterior iris regions make visualization difficult if not impossible without direct imaging.
Endoscopy permits imaging, illumination, and laser application when:
1. Anterior or posterior conditions preclude a posterior view. Examples of these conditions are:
- Opaque Cornea
- Opaque Anterior Chamber
- Small Pupil
- Opacified Lens
- Disrupted Lens Implant
- Gas in Vitreous
2. Viewing anatomy or pathology is not visible through the operating microscope.
- Posterior Iris
- Ciliary Body
- Pars Plana
- Peripheral Retina
- Intraocular Foreign Body
- Dislocated Lens Implants
- Angle (for Goniotomy)
Endoscopy facilitates retinal procedures when conditions, like an opaque cornea preclude viewing thought the surgical microscope.
Endoscopic Removal of Dislocated Soemmering
Endophthalmitis; Streptococcus; Dehiscecne PK
Other advantages of endoscopy
- Wide field viewing from within the eye, 23g and 120°
- Integrated laser application to difficult to access areas
- Good for teaching! “Heads-up” Surgery!
Articles
Endoscope offers versatility over microscope for retinal surgeries.
OT; Feb 15, 2018
While use of the endoscope is widespread, there are still surgeons who feel the microscope is sufficient. However, the increased visualization that the endoscope provides is an invaluable tool that can significantly improve outcomes in a variety of cases, particularly retinal surgeries. Read more...
Endoscopy: An overlooked tool in the management of Ocular trauma
Retina Today; Nov/Dec 2016
Despite a steep learning curve, this instrument can make a big difference. Intraocular foreign bodies (IOFBs) can be found in as many as 40% of penetrating or open globe injuries.1 Penetrating eye injuries can cause permanent loss of vision, corneal ulcers, infection, and sympathetic...
Read more.
Endoscope an Essential Instrument for Every Retina Surgeon
Ocular Surgery News; June 2016
Cases can benefit from improved visibility with the use of the endoscope.
Optimal visualization of the posterior segment is essential in all forms of retinal and vitreous surgical procedures. It becomes even more important when media opacities degrade the view of the retina.
Rupan Trikha, M.D.
Endoscopy and its potential for visualization
Retina Today; Sept 2015
• The endoscope is helpful for examining areas or anatomy of the eye that would otherwise be difficult to view.
• Compared with traditional surgical views, endoscopy allows surgeons to visualize tissues, anatomy, and pathology that might be indiscernible with traditional surgical views.
• Endoscopy-enabled reflected light aids in the visualization of vitreous by causing it to appear more opaque.
Clinical Studies
Endoscopic vitreoretinal surgery: principles, applications and new directions
Int J Retin Vitr 2019, 5:15
Purpose: To analyze endoscopic vitreoretinal surgery principles, applications, challenges and potential technological advances.
Conclusion: Microendoscopy is a robust platform for vitreoretinal surgery. Continuing clinical and technological innovation will help integrate it into the modern ophthalmic operating room of interconnected surgical microscopy,
microendoscopy, vitrectomy machine and heads-up display instrumentation.
RS Ajlan, AA Desai, MA Mainster
Endoscopic Vitrectomy
Current Opinion in Ophthalmology 2014, 25:195-206
Purpose: To update on the recent developments and surgical applications of intraocular endoscopy, and highlight its role in the modern era of microincision vitreoretinal surgery. Recent progress in our understanding of the unique intraocular illumination properties of endoscopy, specifically the use of reflected (coaxial) versus conventional transmitted (dissociated) light, is redefining its role in vitreoretinal surgery.
Wong, S.C., Lee, T.C., Heier, J.S., Ho, A.C.