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Endoscopy beneficial when visualization is limited
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Ophthalmic endoscopy continues to evolve as a powerful technique, especially in the domains of vitreoretinal and glaucoma surgery, namely endoscopic cyclophotocoagulation. Ophthalmic application of endoscopy dates back to 1934, when Thorpe designed an instrument for the removal of nonmagnetic intraocular foreign bodies by combining a Galilean telescope and an illumination source for direct monocular visualization via a 6.5-mm diameter shaft and an 8-mm scleral incision.
Technological advances in ocular endoscopy are evident from the E2 laser and endoscopy system (Endo Optiks), which uses a xenon light source (variable 175 W or 300 W), a diode laser (810 nm), an aiming beam (640 nm) and 23-gauge probes (0.56 mm). Ophthalmic endoscopy bypasses anterior segment opacities to permit visualization of both the anterior and posterior segments of the human eye. It also allows viewing of difficult-to-access areas such as the anterior chamber angle, retroiridial regions such as the ciliary body (pars plana, pars plicata), ciliary sulcus, peripheral lens and anterior retina.
Some of the limitations of ocular endoscopy include postoperative dependence of ultrasonography in cases of opaque anterior segment with poor visualization, extended rehabilitation period when subsequent anterior segment reconstruction is performed for visual improvement, and the surgeon’s learning curve to familiarize with the constant changes in perspective and visualization when using ocular endoscopy.
In this column, Dr. Liao describes the beneficial application of endoscopy in performing surgery in cases of compromised visualization.
Click here to read the publication exclusive, Surgical Maneuvers, published in Ocular Surgery News U.S. Edition, January 25, 2015.