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Subretinal microsurgery with gradient index endoscopes

F H Koch1, K P Luloh, A J Augustin

  • 1University Eye Clinic Frankfurt, Germany.

Ophthalmologica. Journal International D'Ophtalmologie. International Journal of Ophthalmology. Zeitschrift Fur Augenheilkunde
|January 1, 1997
PubMed
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This study introduces a new endoscopic technique for subretinal surgery, enabling direct visualization and improving accuracy. This method avoids retinal incisions, enhancing surgical safety and precision for various retinal conditions.

Area of Science:

  • Ophthalmology
  • Surgical Innovation
  • Medical Devices

Background:

  • Current subretinal surgery requires a retinotomy, limiting visualization and relying on tactile feedback.
  • Existing micro-endoscopes are often too large or lack adequate resolution for intraocular use.

Purpose of the Study:

  • To evaluate a novel 20-gauge gradient index (GRIN) endoscope for direct visualization during subretinal surgery.
  • To assess the feasibility and benefits of endoscopic subretinal surgery compared to conventional techniques.

Main Methods:

  • A 20-gauge GRIN endoscope was introduced into the subretinal space through a scleral/choroidal incision, posterior to the pars plana.
  • Surgical instruments were inserted through a separate sclerotomy for subretinal manipulation under endoscopic guidance.

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  • The technique involved ballooning the retina without creating a full retinal hole.

    • Main Results:

    • Direct visualization of subretinal structures was achieved, allowing for precise dissection of neovascular membranes.
    • Identification and coagulation of feeding choroidal vessels were facilitated, a challenge in conventional surgery.
    • The procedure successfully avoided the need for a retinotomy, minimizing retinal damage.

    Conclusions:

    • Endoscopic subretinal surgery with a 20-gauge GRIN endoscope offers direct visualization, enhancing surgical accuracy and safety.
    • This technique represents a significant advancement over conventional methods, improving the facility of subretinal procedures.