First Author: J. Chhablani INDIA
Co Author(s): S. R. Singh A. Dogra
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Vitreoretinal surgeries in cases of anterior segment opacities were highly challenging in the past. With the advent of endoscopic techniques, vitrectomy is made possible without any concomitant corneal intervention. This video demonstrates the various case scenarios like rhegmatogenous retinal detachment, intraocular foreign body removal in patients with media opacities. Similarly, diagnostic endoscopy facilitates easier decision making in cases where surgical intervention may not be fruitful.
Tertiary care centre based in South India
Endoscopic viewing systems have three components- xenon light source, a charge-coupled device (CCD) camera for image capture and an endolaser. Endoscopic vitrectomy in case of rhegmatogenous retinal detachment involves surgical steps similar to conventional vitrectomy including vitrectomy, break identification, endolaser and silicone oil injection. The differences such as side on viewing, 2 dimensional view, learning curve for orientation, magnification; provide certain unique challenges to the surgeons.
The endoscopic vitrectomy provides acceptable results in some of these non-salvageable eyes with anterior segment opacities. Early removal of Intraocular foreign body through limbal route can help prevent its encapsulation and development of endophthalmitis. Eyes with keratoprosthesis in situ regain visual acuity post retinal detachment surgery i.e vitrectomy and silicone oil tamponade. Similarly, diagnostic endoscopy helps visualize optic disc and macula, presence of ciliary body membranes thereby helping in prognostication and planning any future surgeries.
Endoscopic techniques provide a new surgical tool in armamentarium of vitreoretinal surgeons. It provides a completely different perspective as compared to conventional vitrectomy. However, the learning curve is steep along with certain inherent limitations such as 2 dimensional view, absence of bimanual instrumentation at present and difficult postoperative evaluation. On the other hand, it eliminates blind spots with visualization & accesss to areas unaccessible with conventional viewing systems.