Endoscopy is advantageous in traumatized eyes

ROME — Endoscopy can be valuable in trauma surgery, Claude Boscher, MD, said. Inadequate visualization in a traumatized eye can make surgery time consuming, and delay can lead to further complications such as formation of anterior proliferative vitreoretinopathy.

“Endoscopy completely bypasses the problem of media transparency. In a case of a completely opacified cornea, you can operate inside the eye without performing a corneal graft, and eventually select keratoplasty for only the eyes where retinal problems have been solved,” Dr. Boscher said.

Endoscopy also allows surgeons to decrease the risk of anterior proliferative vitreoretinopathy, proliferative vitreoretinopathy development and ciliary scarring and secondary hypotony, she told attendees here at the International Society of Ocular Trauma meeting.

An endoscope allows surgeons to “perform an early removal of blood and an early removal of the entire vitreous base, whatever the conditions of the anterior segment,” she said. “You can also explore the posterior pole and evaluate the conditions of the retina before injecting [perfluorocarbon liquid] and control all subretinal maneuvers.”

Silicone oil removal can be performed more easily and thoroughly with endoscopy. Dr. Boscher said. The instrument is able to detect all the droplets of silicone oil trapped into the ciliary processes over the pars plana and the zonular system, preventing the risk of secondary glaucoma, she said.

Dr. Boscher has developed an autoclavable probe that should alleviate sterilization concerns. She stressed the importance of cleansing the superior part of the anterior vitreous base and dissecting any connection with the anterior segment at 360°. If left there, even small quantities of vitreous are able to redetach the retina or, in presence of a flat retina, to cause hypotony. A thorough cleansing of the ciliary margin, where stem cells are produced, also removes all the inflammatory cells that have been stimulated by the trauma.

Additionally, “tearing is not a big problem with endoscopy because you are controlling your maneuvers all the time,” she pointed out.

Endoscopy-guided vitreoretinal surgery requires a learning curve that has often discouraged surgeons from using this technique. A major stumbling block for some surgeons is using only one hand to operate, as the other is used to hold the endoscope.

“However, learning to use the endoscope is easier than one might think, provided that specific instruments are used,” Dr. Boscher said.