Cesare Forlini Ravenna, Italy

The use of non-contact panoramic systems allows remarkable advantages when compared to non-panoramic systems and contact panoramic systems themselves.
The advantages are related especially to the panoramic view and consequently to the opportunity to have a complete control of fundus during the various steps of vitreo-retinal surgery.
Advantages include the possibility to have a very good visualization also through very small pupils which otherwise would require mechanical stretching in the case a non-panoramic system is used.
In addition, the surgeon doesn’t need to be helped for surgical manoeuvers by the assistant who is crucial on the contrary when contact systems are used.
Of course, a non contact panoramic system must be used in conjunction with a special wide angle fiberoptic to allow a panoramic view.
Recently, several wide angle fiberoptic systems have been conceived coupled both with a probe and other surgical devices such as pics or scissors so that bimanual manoeuvers are possible.
Using non contact panoramic systems the risk of iatrogenic complications is decreased and their control is easier and quicker. The surgical procedure itself is faster and this represents a safety factor as well.
Against these advantages, some disadvantages must be taken into account: less stereopsis, flattening of the image, and therefore risk of touching the retina especially outside the arcades and learning curve.
Learning curve for those surgeons who, like myself, come from conventional systems (various types of contact lenses) passing through contact panoramic systems to get to non contact panoramic systems such as BIOM 2, requires long times.
In my “school”, young surgeons soon start to use BIOM without using first other systems and their learning curve has been fast with consequent fast surgical learning curve.
Their routinary use, improving surgeon’s confidence, gradually allows the use of panoramic system (BIOM+wide angle light) also for macular diseases, such as macular hole and pucker, once operable only with conventional systems.