New era in endoscopic vitreoretinal surgery

Effects of Image Processing Using Honeycomb-Removal and Image-Sharpening Algorithms on Visibility of 27-Gauge Endoscopic Vitrectomy

Endoscopic vitrectomy with small gauge probes has clinical potentials, but intraocular visibility is inherently limited by low resolution and dim illumination due to the reduced number of optic fibers. We investigated whether honeycomb-removal and image-sharpening algorithms, which enable real-time processing of live images with a delay of 0.004 s, can improve the visibility of 27-gauge endoscopic vitrectomy. A total of 33 images during endoscopic vitrectomy were prepared, consisting of 11 original images, 11 images after the honeycomb-removal process, and 11 images after both honeycomb-removal and image-sharpening procedures. They were randomly presented to 18 vitreous surgeons, who rated each image on a 10-point scale. The honeycomb-removal algorithm almost completely suppressed honeycomb artifacts without degrading the background image quality. The implementation of image-sharpening algorithms further improved endoscopic visibility by optimizing contrast and augmenting image clarity. The visibility score was significantly improved from 4.27 ± 1.78 for the original images to 4.72 ± 2.00 for the images after the honeycomb-removal process (p < 0.001, linear mixed effects model), and to 5.40 ± 2.10 for the images after both the honeycomb-removal and image-sharpening procedures (p < 0.001). When the visibility scores were analyzed separately for 10 surgeons who were familiar with endoscopic vitrectomy and 8 surgeons who were not, similar results were obtained. Image processing with honeycomb-removal and image-sharpening algorithms significantly improved the visibility of 27-gauge endoscopic vitrectomy.

Endoscopy-assisted vitrectomy vs. vitrectomy alone: comparative study in complex retinal detachment with proliferative vitreoretinopathy

Background

Recurrent retinal detachment (RD) is still a widespread event despite the therapeutic options available. Proliferative vitreoretinopoathy (PVR) is one of the main causes of redetachment. Little is known about the use of endoscopy-assisted vitrectomy (E-PPV) in complex recurrent RD with PVR. The purpose of this study was to identify the potential advantages of E-PPV in complex RD with PVR compared with pars plana vitrectomy (PPV) alone.

Methods

Single-center, retrospective, observational, descriptive study. The medical records of 293 patients were reviewed. Patients who underwent PPV for complex rhegmatogenous RD and associated PVR between 2009 and 2017 were included. Patients with diabetic tractional RD, trauma, uveitis or detachment postendophthalmitis were excluded. After 2013, an endoscopic visualization system was used in a nonrandomized fashion at the surgeon’s discretion. Outcome measures (reattachment rate, number of surgeries, lens status, PVR stage, intraocular pressure, phthisis rate) were compared between the E-PPV and PPV-only groups with independent samples t-tests (continuous variables) and Fisher’s exact test (categorical variables), as well as time-adjusted analyses. Postoperative time to retinal redetachment was assessed with Kaplan–Meier survival analysis.

Results

One hundred one eyes from 100 patients met the inclusion criteria. The mean participant age was 63.3 years old (95% CI 60.4–66.1 years), without a significant difference between groups. E-PPV was performed in 36.6% (n = 37) of eyes, and 63.4% (n = 64) underwent PPV only. The mean follow-up was significantly longer in the PPV-only group (31.9 vs. 21.1 months; p = 0.021). Upon adjustment for follow-up duration, the mean number of surgeries was significantly lower in the PPV-only group (2.6 vs. 4.3 number of surgeries; p < 0.001) than in the E-PPV group. A significantly higher risk for redetachment was observed in the PPV-only group (HR [95% CI] 4.1 [1.4–11.8]) than in the E-PPV group (p = 0.037). The evolution to phthisis was 7% (n = 4) in the PPV-only group and 2.7% (n = 1) in the E-PPV group (p > 0.05).

Conclusions

Compared to PPV alone, endoscopy-assisted vitrectomy seems to be advantageous in achieving better reattachment rates in complex RD with advanced PVR. Endoscopic visualization allows a thorough examination and extensive anterior PVR and vitreous base dissection.