A recent essay published by David Liao, MD, PhD, in Ophthalmology Times studies the use of an endoscope in order to improve the outcome of eye surgeries.
Traditional operating microscopes have been known to be easily corrupted during pre-operation practices. Yet endoscopes, Liao writes, are great backups in the event that visualization becomes difficult during the operation.
For successful retinal surgeries, being able to visualize pathology is essential. So when an operating microscope stops working before or during the operation, the endoscope provides a great backup service. Leaving this available to the surgeon can give them the confidence they need to complete the surgery.
The endoscope is especially helpful in cases where some of the eye is blocked. This happens in some cases of prolonged retinal detachment and/or trauma. Since these often result in major cornea or lenticular issues, the endoscope can stand in and help in visualization.
“At times, I also use the endoscope to locate and remove anteriorly situated retained lens fragments and for membrane peeling in cases of anterior loop proliferative vitreoretinopathy,” Liao says.
Sometimes, he adds, medical professionals may start with a routine surgery that becomes more complicated as the surgery progresses. The endoscope helps in visualization in these cases, which gives the surgeon a huge advantage when it comes to safety and surgery outcomes.
Liao says the endoscope can be especially helpful in complex surgeries, where landmarks the surgeon needs to work off of are distorted. When they begin, the endoscope may be disorienting, but as they progress, the surgeon may use it in order to “view the retina from a shorter distance and at various angles.”
Liao points to a case study in which a 72-year old woman had gone through a complicated cataract surgery three years prior to seeing him, and had been given a PMMA lens placed in her sulcus.
“There was optic capture, with the malposition resulting in a low grade iritis,” he writes. “The patient also had a significant macular pucker. After treating the inflammation topically, I thought removing the lens would be a simple case of dialing it into the anterior chamber. I did not anticipate using the endoscope. The lens mobilized easily at first. However, after completing the rotation, I noticed that the inferior haptic had fractured and remained hidden behind the iris.”
He says he may have been able to leave it in its place, but it could have caused even more issues down the line. The endoscope allowed him to see behind the iris and complete the surgery relatively easily.
Further advances in this technology will not only make these surgeries easier, but could also make it easier for patients to recover. Currently, patients are required to lay face down for 50 minutes of every hour, while taking the remaining 10 minutes to stretch, use the bathroom, shower, and eat.
Luckily, it looks as though this technology will only continue to grow. TechNavio reports that the market will grow by about 7.32% from 2014 to 2019 on their Global Retinal Surgery Devices Report.