Intraocular endoscopy: A review

Abstract

Optimal visualization is one of the most challenging aspects of performing vitreoretinal surgery. In situations where conventional microscopic techniques provide poor posterior visualization, the adjunctive skill set of endoscopic visualization may be needed. This allows for by-passing the opaque anterior segment media and getting access to the posterior segment pathology. Endoscopic vitrectomy is a useful and unique adjunct to microincision vitreoretinal surgery. The optical set-up of endoscopy allows for clinical approaches that are impossible with regular microscope viewing systems. These include the ability to observe across optically significant anterior segment opacities and directly visualize the posterior segment of the eye. It also allows for visualizing the difficult-to-access retroirideal, retrolental, and anterior retinal structures. Surgical access to anatomic spaces like the pars plana, pars plicata, ciliary sulcus, ciliary body, and peripheral lens is tedious. This is made simpler by endoscopy. In this review, we summarize and review the usage of the intraocular endoscope as a diagnostic and therapeutic armamentarium across a wide spectrum of ocular pathologies.

Keywords: Diagnostic endoscopy; endoscopic visualization; endoscopic vitrectomy; endoscopy; intraocular endoscopy.

Figure 1

Panel showing peripheral ciliary body membrane (a) with the corresponding membrane on the ultrasound biomicroscopy (b)

Figure 2

Panel showing an endoscopic view of rhegmatogenous retinal detachment (a), peripheral proliferative vitreoretinopathy dissection (b) and finally an attached retina (c)

Figure 3

Panel showing hazy cornea with no anterior chamber view (a), endoscopic evaluation showing a dropped intraocular lens (b) and the explanted intraocular lens (c)

Figure 4

Panel showing endophthalmitis with hazy anterior segment view (a), necrotic retina (b), intraocular foreign body (c), and foreign body being removed by an intraocular magnet (d)

Figure 5

Panel showing endophthalmitis with hazy anterior segment view (a) and dense exudates in the vitreous cavity with necrotic retina (b)

Figure 6

Panel showing post keratoplasty eye with endophthalmitis (a), conventional view showing a very hazy vitreous cavity with poorly visible retinal detachment (b, arrow) and endoscopic view clearly showing the detachment and a peripheral necrotic break (c)

Figure 7

Panel demonstrating diagnostic endoscopy prior to keratoprosthesis surgery. Vascularized thinned out cornea seen (a) and endoscopic view reveals attached viable retina with mild disc pallor (b)