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Jean-François Le Rouic (Nantes, France)

Purpose:

The treatment of complex retinal detachments requires a meticulous dissection of both the posterior and the peripheral fundus. Despite intraoperative scleral depression, the access of the peripheral fundus is sometimes hindered by poor dilatation and anterior segment media opacification. The visualization of the peripheral fundus with intraocular endoscopy does not depend of these factors. Intraocular endoscopy may then be associated with conventional lenses to provide a comprehensive viewing of the entire fundus. We herein, report the advantages and the limits of this combined use in the treatment of complex RD.

Methods:

Thirteen eyes of 13 patients were operated for complex retinal detachment using 3-port 20 Gauge pars-plana vitrectomy, intraocular endoscopy, direct lenses, and wide field lens. Surgery was performed for RD with PVR in 11 cases, recurrent RD after silicone oil removal in one case, and RD after traumatic wound dehiscence following penetrating keratoplasty in one case. In 11 cases, the eye had undergone a previous vitrectomy.

Results:

The intraocular endoscope allowed the detection of intraoperative vitreous incarceration in a sclerotomy in 2 cases, previous vitreous incarceration in 6 cases, retraction of the residual anterior vitreous in one case, and complete removal of PFCL despite a cloudy cornea in one case. These features could not be seen, or hardly with conventional lenses.

Discussion:

The combined use of conventional visualization system and intraocular endoscopy is complementary and helpful. However, numerous limitations of intraocular endoscopy prevent a routine use of this association. They include: the extra cost due to endoscope utilization, the average quality of the image provided by actual endoscopes, and the necessity to perform 20 gauge vitrectomy.

Conclusion:

Once improved, intraocular endoscopy may currently be used in association with conventional visualization systems to enhance the results of complex RD surgery.