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.
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!
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.