Frank Koch Frankfurt, Germany

Like a variety of wide field contact lens systems, the non contact BIOM guarrantees wide field observation in the vitreous cavity.
Either in the latest rod model or the 1st generation tube BIOM, a two lens system is easily attached to the microscope.
Once you need wide field viewing you swing in the rod or tube, activate the stereodiagonal inverter SDI, zoom in and focus by turning the rod or the tube.
For a fully bimanual work, the use of the Insight Instruments self sealing multiport illumination system MIS releases you from holding a light pipe or selected illuminated instruments.
You introduce 20 gauge instruments through the illuminated MIS ports thus automatically  illuminating your working field.
Out of a variety of MIS port setups with different advantages mentioned here you can choose:
A 3 MIS port setup for a variable positioning of the miniinfusion, a two MIS port setup using a standard miniinfusion, and different setups with one ore two MIS ports and one open sclerotomy.
For the last setup shown here a special MIS miniinfusion is provided.
To facilitate the insertion of the tube through a 19 or 20 gauge pars plana incision 4 mm into the vitreous cavity you should use a scleral spreading device.
You press the upper half of the spreading device and insert the tube before you press the lower half and remove the spreader.
The BIOM-MIS setup guarrantees you a view from the disc to the ora even when viewing through poorly dilated pupils.
This MIS setup facilitates the identification of the full extent of epiretinal membranes and the subsequent segmentation and allows truly bimanual peeling with careful handover techniques.
Even in disastreous cases, the surgeon can safely cut along the edge of retinal breaks and avoid creation of giant tears in the retina, which could be produced by simply pulling on the fibrovascular membrane.
During and after a fluid-air exchange the surgeon has full control of the performance. When a fluid air exchange has to be performed in a phacic eye, surgeon has to focus the BIOM upwards and simultaneously lower the microscope down to standard distance to the cornea (8 – 12 mm) before he starts to perform the fluid-air exchange. He than will gain focus back shortly before the end of exchange. In highly myopic eyes removal of reduction lens may be necessary in selected cases.
When using the self sealing MIS he can continue to remove vitreous in the outermost periphery in a completely air filled eye.
If transparency of medias interferes with the microscopic control the Insight Instruments GRIN endoscope allows careful lifting of membranes  and simultaneous laser coagulation under high resolution control.