External Illumination Options for Vitreoretinal Service Provided in the Operating Room, an Ambulatory Surgery Center or in the Office

Abstract

 

Purpose:

 

To analyze strategies (indirect ophthalmoscopy, diaphanoscopy) to reduce numbers of entry sites for performing a pars plana vitrectomy (PPV) in different surgical environments.

 

Methods:

 

To reduce the numbers of entry sites for performing a PPV, vitreoretinal surgeons can illuminate from outside. By using the light of the Indirect Ophthalmoscope (IO) a removal of the vitreous from the center of the vitreous cavity (core PPV) can be performed safely and efficiently using a one site Intrector (23g monoprobe vitrectomy) or 2 or 3 port PPV systems. Then, the modern "bright light " diaphanoscopy allows to perform delicate interventions as ILM peeling under the microscope with light applied from outside. We reviewed over 4500 monosite pars plana vitrectomy (Intrector®) interventions and 39 diaphanoscopic interventions. We analyzed the specific advantages of this extraocular illumination approaches as well as its limitations.

 

Results:

 

A core PPV can be performed using the Indirect Ophthalmoscope. The complication rate in over 4500 monosite Intrectomy interventions was 0,44 % (mainly endophthalmitis, cataract, retinal detachments). The dynamics of indentation with the tip of the diaphanoscope as well as a superb depth of field perception, tangential viewing angles and a reflex-free imaging even under gas allow excellent work being performed at the vitreoretinal interface. Fig. 1 The "bright light " diaphanoscope can be powered with just a 150 halogen light bulb and is characterized by filtered light with cut offs below 490 nm and above 780 nm. At no time the tip of the device gets warm. No postoperative examination (OCT, Fluorescein Angiography) or papers revealed any signs of light toxicity so far.

 

Conclusions:

 

Extraocular illumination options as light from the indirect ophthalmoscope or the "bright light" diaphanoscope facilitate the PPV procedure in different surgical environments as the operating room, an ambulatory surgery center and in the office.  

 

Keywords: vitreoretinal surgery • brightness and lightness • laser