Endoscope a versatile tool

Dr Heier, who has been using 19- and 20gauge endoscopes for complicated cases during the past 6 or 7 years, said that the new 23gauge instrument can be used more often because it doesn't require removing a cannula or opening up larger sclerotomies to perform a case.

The new endoscope, which he has used for about a year, has been helpful in complicated cases in which his view has been compromised by anterior segment trauma, damage, or disease or when visualization of anterior structures such as those posterior to the iris is an issue.

He has also used the 23gauge endoscope for complicated detachments and severe endophthalmitis as well as chronic hypotony cases in which the eye develops anterior proliferation of membranes that grow over the ciliary processes.

Use in routine or complicated cases

The endoscope is also useful when confronting diagnostic dilemmas, Dr Heier said. For instance, it can be used to identify pathology that couldn't normally be seen, such as retained lens material, inflammatory debris, or other structures behind the iris.

He has also found a niche for the endoscope when assisting glaucoma specialists in the placement of a posterior tube shunt.

"It enables me to visualize the tube and surrounding structures as well as the vitreous," Dr Heier added. "The visualization of the vitreous is much clearer because of the way the endoscope works, and the visualization of structures in their natural position, without having to use scleral depression, is very helpful.

"I find endoscopes in general very helpful for these complicated cases, but the fact that we now have a 23gauge with adequate resolution to take care of these cases makes it much easier to adapt in the operating room," he continued. "It goes right through any of the 23gauge cannulas and it has three functions: it is an endoscope, a light source and a laser source."

The laser endoscope has a video component that enables the surgeon to visualize the tissues on the monitor during procedures. The instrument is typically used because of a compromised view or the location that is being viewed, such as posterior to the iris, where the video component offers direct visualization.

The endoscope is also helpful in managing a sutured IOL in which one of the haptics has become dislocated while the other is still sutured in place but has become fibrotic.

"The endoscope enables me to visualize those tissues and then release the suture and the fibrosis more easily, and most importantly, more safely remove the IOL," Dr Heier said.

The 23gauge endoscope is valuable in routine cases as well as more complicated procedures. Since acquiring this endoscope, Dr Heier has been more likely to use it in straightforward cases, such as a routine retinal detachment with a silicone IOL in which the view is compromised by condensation on the lens or air in the anterior chamber.

"It's easy for me to bring out the endoscope quickly and have an excellent view," he said.

Special contributorDr Jeffrey S. Heier is vitreoretinal specialist for the Ophthalmic Consultants of Boston, Massachusetts, USA. He may be reached by E-mail: jsheier@eyeboston.com
; anowak@eyeboston.com

Dr Heier did not indicate any financial interest in the topic.