INTRODUCTION In 1934, Thorpe developed a nonilluminating ophthalmic endoscope. It was until 1978 that Norris and Cleasby developed a significantly smaller, 1.7-mm diameter endoscope, for intraocular and orbital surgery. Endoscopic vitrectomy was first described in 1981. In 1990, a 20-gauge endoscope with image projection on an electronic monitor was described. This instrument has been usefull in adults for traumatic RD, proliferative vitreoretinopathy (PVR), retained lens fragments, endophthalmitis, sutured posterior-chamber intraocular lens placement, rhegmatogenous RD, and pediatric retinal pathology in conditions such as advanced ROP and familial exudative vitreoretinopathy (FEVR). We use endoscopy in complicated cases of ocular trauma and clear media opacity. OBJETIVE To evaluate the use of intraocular endoscopic surgery with EndoOptiks® in vitreoretinal surgery in eyes with severe ocular trauma and in cases with opaque media. METHODS Retrospective study of eleven surgeries in eyes with complicated ocular trauma or eyes with opaque media, carried out at during 2011.

USE OF ENDO OPTIK® IN COMPLICATED CASES OF SEVERE OCULAR TRAUMA AND CLEAR MEDIA OPACITY REPORT OF 11 CASES.

CLINICA OFTALMOLÓGICA EL VIÑEDO SERVICE OF RETINA AND VITREOUS. VALENCIA - VENEZUELA

Suarez-Tatà Luis; Suarez-Tatà Moravia; Rodriguez Sanna L, García Reinaldo; Rodriguez Gonzalez L. NOT INTEREST COMMERCIAL

Tabla no. 5 TOTAL Avastin-Lucentis ODI-OD-OI 2008-2010

AGE  (Yrs)   Sex   INICIAL  VA     VA    FINAL  (6  mths)   DX   Complica?ons  

32   M   HM   20/80   IOFB  /VH  /RD  

34   M   HM   NLP   IOFB  EndoN   Ph?sis  bulbi  

82   F   LP   20/100   Corneal opacity/  VH   RD  

24   M   HM   20/60   Penetra?ng  corneo-­‐scleral  injury  

41   M   LP   20/80  Penetra?ng  corneo-­‐scleral  

injury  /  lens/  VH  /  CD  

22   M   HM   20/100   IOFB  EndoN  

18   M   HM   20/60   IOFB  EndoN  

64   F   HM   HM   Corneal opacity/  VH  

35   M   HM   20/60   Penetra?ng  corneo-­‐scleral  injury  

65   M   HM   20/40   Corneal opacity  74   F   HM   20/50   Corneal opacity  

RESULTS A total of eleven surgeries were done in 2011 at the Vitreoretinal Service of the Clínica Oftalmológica El Viñedo. Postoperative complications were observed in 2 eyes: one eye with retinal detachment and the other eye with phthisis bulbi. In the remaining 9eyes, mean functional visual acuity was 20/60 (20/20 to 20/100). Table 1 DISCUSSION An endoscopic vitreoretinal surgery may be used in cases where the eye has sustained a perforating corneal injury and vitreoretinal complications. Combined vitrectomy and simultaneous keratoplasty have been reported to be beneficial. However, an open-sky procedure in a perforated eye may cause intraoperative and postoperative complications, including suprachoroidal hemorrhage and early corneal graft failure.Therefore, a closed-eye procedure is believed to be safer when perforation has occurred. In addition, when endophthalmitis may have occurred following traumatic injury, the risk of primary graft failure is higher; andsubsequent corneal regrafting also carries a higher risk of graft rejection due to persistent inflammation. The intraoperative endoscopic approach adopted in our study allowed Observation of the ciliary sulcus, pars plana, and vitreous base, enabling us to observe an intraocular foreign body in a perforated eye that might have gone undetected otherwise. Although the endoscopic view itself is non-stereoscopic, shadows created by intraocular surgical instruments and endoscopic illumination may provide pseudo-stereoscopic images, allowing estimation of the distance between the intraocular surgical instruments and the retina. However, this indirect sensing of space and dimension differs from that achieved with an operating microscope. Therefore, greater caution may be required in estimating space and dimension in endoscopic procedures during surgery. The endoscope has a broad range of applications particularly relevant to severe ocular trauma and in case of corneal opacities. In our practice, posterior-segment endoscopy has been a significant and indispensable for retina specialists’ surgical armamentarium. As technology evolves, there are several potential developments. The most significant advance will probably be the goal of stereoscopic visualization to be possible, whether with 3D glasses on a monitor, or piped into the eyepieces of the operating microscope. As the resolution of fiber optics increases and instrument size decreases, stereoscopic visualization will soon become a reality.

TABLE 1

CONCLUSIONS The probability of achieving functional visual acuity in eyes with severe ocular trauma and in those where optimal visualization of surgical anatomy is difficult, is very limited. EndoOptik® is a novel endoscopic surgical system that aids intraoperative evaluation complementing it with greater detail, thus achieving better comprehension and allowing surgical resolution of complications in eyes with trauma, and in eyes with opaque media that require vitreoretinal intervention. Further studies and new technologies will allow improved functional visual results. REFERENCES Thorpe HE. Ocular Endoscope: An instrument for the removal of intravitreous nonmagnetic foreign bodies. Tr Am Acad Ophthalmol. 1934;39:422. Thorpe HE. Nonmagnetic intraocular foreign bodies. JAMA. 1945;127(4):197-204. doi:10.1001/jama.1945.02860040007002. Norris JL, Cleasby GW. An endoscope for ophthalmology. Am J Ophthalmol. 1978;85:420-422. Volkov VV, Danilov AV, Vassin LN, Frolov YA. Flexible endoscopes. Ophthalmoendoscopic techniques and case reports. Arch Ophthalmol. 1990;108(7):956-957. Shen L, Zheng B, Zhao Z, et al. Endoscopic vitrectomy for severe posttraumatic endophthamitis with visualization constraints. Ophthalmic Surg Lasers Imaging. 2010;41(1):e1-e4. doi:10.3928/15428877-20100215-46. Pantcheva MB, Seibold LK, Kahook MY. Endoscopic cyclophotocoagulation. Cataract and Refractive Surg Today. 2011;Nov:35-39. Morishita S, Kita M, Yoshitake S, et al. 23-gauge vitrectomy assisted by combined endoscopy and a wide-angle viewing system for retinal detachment with severe penetrating corneal injury: a case report. Clin Ophthalmol. 2011;5:1767-1770. doi:http://dx.doi.org/10.2147/OPTH.S25373. Lakhanpal RR, Sun RL, Albini TA, Holz ER. Anatomical success rate after primary three-port lens-sparing vitrectomy in stage 5 retinopathy of prematurity. Retina. 2006;26(7):724-728. doi:10.1097/01.iae.0000244274.95963.1e. Kawashima M, Kawashima S, Dogru M, et al. Endoscopy-guided vitreoretinal surgery following penetrating corneal injury: a case report. Clin Ophthalmol. 2010;4:895-898. :http://dx.doi.org/10.2147/OPTH.S12435.

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