Koch F. H. J.

JWG-Universität, University Eye Clinic, Frankfurt/Main; University Eye Clinic, Mainz

Introduction: Since the physical properties of endoscopes were significantly improved over the last 10 years, more and more surgeons report about their experiences working with either fused fibre endoscopes or solid rod gradient index endoscopes in the vitreous cavity. The 20- and 19 gauge diameter microendoscopes consist of an optical channel, light fibers and at least one working channel, so that infusion and/or aspiration and/or laser coagulation can be delivered through the endoscope. Basically, other than a microscope, endoscopes guarrantee a clear image independent on media transparencies of cornea or lens and also in the subretinal space.
Devices and Techniques: Fused fibre endoscopes deliver the image through a lens in the handpiece and a long bundle of light fibres to the camera; in solid rod endoscopes the image is transmitted through a lens and a short glas rod to the camera, all integrated in the handpiece. The more powerful light of fused fibre endoscopes and the significant better resolution of solid rod endoscopes are the main differences of surgical relevance but in both systems a physical light shutter should be integrated in order to limit the light toxocity risks to the retina. Basically, all endoscopes are introduced into the vitreous like any other instrument via the pars plana. They can also be moved forward through a small retinal hole behind the retina or via the sclera and chorioidea (back door method without retinal hole). The image of the endoscope optics is projected to a TV monitor, LCD screens or into the microscope ocular.
Indications and Results: All endoscopes are powerful endo-illumination devices combined with an optic and a working channel for optically control and maneuvers in e.g.: peripheral holes, vitreous incarcerations in the scleral wound, anterior hyaloidal fibrovascular proliferations, endocyclophotocoagulation, implantation of sustained release intraocular devices, removal of transparent membranes in macula pucker and macula holes, sheathotomy in branch vein occlusion, and in subretinal surgery including membrane removal and laser coagulation of CNV´s, retinal translocation and pigment epithelium cell transplantation.
Discussion: All video-microendoscopes work sufficiently in the vitreous filled with water, air, perfluorocarbon or silicone oil. Whether behind the retina the solid rod gradient index endoscope is best working under BSS, viscous solutions or heavy liquids, and how the subretinal delivery of different lasers and laser energies can be optimized is under current investigation.

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