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Parameswarappa DC, Dave VP, Tyagi M, Pappuru RR. Endoscopy-assisted pars plana lensectomy for brunescent cataracts in eyes with microcornea with microphthalmos. Semin Ophthalmol 2021; 37:7-10. [PMID: 33689556 DOI: 10.1080/08820538.2021.1896755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purpose: Conventional cataract surgeries can be a challenge in eyes with microcorneas due to difficult manipulation in a crowded anterior chamber (AC) and can lead to a high occurrence of corneal edema and an increased rate of complications. Similarly, in cases of dense brunescent cataracts even a lensectomy through posterior approach may prove to be difficult because of inadequate visualization. An endoscopyassisted pars plana lensectomy can help in obviating these difficulties. This study aims to describe the surgical technique of endoscopy-assisted pars plana lensectomy in eyes with brunescent cataract, microcornea, and microphthalmos.Methods: Retrospective review of two cases where endoscopy-assisted pars plana vitrectomy and lensectomy was performed for patients with dense cataract and microcornea and microphthalmos.Result: Complete clearance of the cataract was achieved without having to resort to a sclerocorneal incision. Postoperatively the cornea was clear and there was no postoperative corneal edema.Conclusion: Endoscopy-assisted pars plana lensectomy can help in overcoming the challenges of conventional anterior and posterior approaches of cataract extraction in cases of microcornea with reduced intraoperative and postoperative complications.
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Affiliation(s)
- Deepika C Parameswarappa
- Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Vivek Pravin Dave
- Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Mudit Tyagi
- Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
| | - Rajeev R Pappuru
- Smt. Kanuri Santhamma Centre for Vitreoretinal Diseases, LV Prasad Eye Institute, Hyderabad, India
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Lai FHP, Wong EWN, Lam WC, Lee TC, Wong SC, Nagiel A, Lam RF. Endoscopic vitreoretinal surgery: Review of current applications and future trends. Surv Ophthalmol 2020; 66:198-212. [PMID: 33278403 DOI: 10.1016/j.survophthal.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
Endoscopy provides unique optical properties to circumvent anterior segment opacities and visualize difficult-to-access anatomical regions, including retroirideal, retrolental, ciliary body, and anterior retinal structures. We summarize the basic principles and utilization of endoscopic vitreoretinal surgery, along with recent technological advances in the field base on a structured literature search in Pubmed, Embase, and Google Scholar database up to February, 2020. Endoscopy has been used in the management of retinal detachment, ischemic retinopathies with neovascular glaucoma, severe ocular trauma, endophthalmitis, lens-related disorders in the posterior segment, pediatric vitreoretinal diseases, and implantation of retinal prostheses. Ongoing development of endoscopic technology aims to provide higher resolution images with endoscopes of smaller diameter. New surgical techniques supported by the adoption of endoscopy are available to manage challenging surgical scenarios. Endoscopy can be a useful adjunct to microscope wide-angle viewing systems in the management of complex vitreoretinal diseases.
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Affiliation(s)
| | | | - Wai Ching Lam
- Department of Ophthalmology, The University of Hong Kong, Hong Kong; Department of Ophthalmology and Vision Science, University of Toronto, Ontario, Canada
| | - Thomas C Lee
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Sui Chien Wong
- Great Ormond Street Hospital for Children, London, England; National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital & UCL Institute of Ophthalmology, London, England; Royal Free Hospital, London, England
| | - Aaron Nagiel
- The Vision Center, Department of Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA; USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Robert Fung Lam
- Department of Ophthalmology, Caritas Medical Centre, Hong Kong
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Orellanos-Rios J, Yokoyama S, Bhuiyan A, Gao L, Otero-Marquez O, Smith RT. Translational Retinal Imaging. Asia Pac J Ophthalmol (Phila) 2020; 9:269-277. [PMID: 32487917 PMCID: PMC7299229 DOI: 10.1097/apo.0000000000000292] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 04/03/2020] [Indexed: 11/25/2022] Open
Abstract
The diagnosis and treatment of medical retinal disease is now inseparable from retinal imaging in all its multimodal incarnations. The purpose of this article is to present a selection of very different retinal imaging techniques that are truly translational, in the sense that they are not only new, but can guide us to new understandings of disease processes or interventions that are not accessible by present methods. Quantitative autofluorescence imaging, now available for clinical investigation, has already fundamentally changed our understanding of the role of lipofuscin in age-related macular degeneration. Hyperspectral autofluorescence imaging is bench science poised not only to unravel the molecular basis of retinal pigment epithelium fluorescence, but also to be translated into a clinical camera for earliest detection of age-related macular degeneration. The ophthalmic endoscope for vitreous surgery is a radically new retinal imaging system that enables surgical approaches heretofore impossible while it captures subretinal images of living tissue. Remote retinal imaging coupled with deep learning artificial intelligence will transform the very fabric of future medical care.
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Affiliation(s)
| | - Sho Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization, Chukyo Hospital, Nagoya, Aichi, Japan
| | | | - Liang Gao
- Department of Biomedical Engineering, UCLA, LA, Los Angeles, CA, USA
| | - Oscar Otero-Marquez
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - R. Theodore Smith
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kita M, Kusaka M, Yamada H, Hama S. Three-dimensional ocular endoscope system for vitrectomy. Clin Ophthalmol 2019; 13:1641-1643. [PMID: 31695313 PMCID: PMC6717706 DOI: 10.2147/opth.s221197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To introduce a new three-dimensional (3D) endoscope system for vitrectomy. SUBJECTS AND METHODS We report a single-center, retrospective, consecutive surgical case series of 391 eyes that underwent 25G hybrid vitrectomy. To create 3D endoscopic images, a 3D converter HD-3D-A was connected to a monocular endoscopic system. RESULTS The 3D endoscope system was successfully used to perform hybrid vitrectomy. No intra- or postoperative complications related to this system were encountered in any of the cases. CONCLUSION This 3D endoscope system appears to be a valuable and promising tool for use in vitrectomy.
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Affiliation(s)
- Mihori Kita
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Mami Kusaka
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Hiroshi Yamada
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Sachiyo Hama
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
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Yu YZ, Zou YP, Zou XL. Endoscopy-assisted vitrectomy in the anterior vitreous. Int J Ophthalmol 2018; 11:506-511. [PMID: 29600187 DOI: 10.18240/ijo.2018.03.23] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 01/12/2018] [Indexed: 11/23/2022] Open
Abstract
Endoscopy-assisted ocular surgery is a relatively old technique that is increasingly being recognized for its application in cases of vitreoretinal disease. This technique is especially useful when both the vitreous and retina are difficult to access because of media opacity, a small pupil, or a microcornea. In this context, the anterior vitreous is often difficult to dissect because of its complex pathological changes. This article reviews the common anatomical features and pathologies that are observed in the anterior vitreous, as well as the applications and indications of endoscopy-assisted vitrectomy in the anterior vitreous.
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Affiliation(s)
- Yong-Zhen Yu
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, Guangdong Province, China
| | - Yu-Ping Zou
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, Guangdong Province, China
| | - Xiu-Lan Zou
- Department of Ophthalmology, Guangzhou General Hospital of Guangzhou Military Command of PLA, Guangzhou 510000, Guangdong Province, China
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Kita M, Fujii Y, Hama S. Twenty five-gauge endoscopic vitrectomy for proliferative vitreoretinopathy with severe corneal opacity. Jpn J Ophthalmol 2018; 62:302-306. [PMID: 29460017 DOI: 10.1007/s10384-018-0578-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 01/18/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE To report 4 cases undergoing 25-gauge endoscopic vitrectomy for the treatment of proliferative vitreoretinopathy with severe corneal opacity in which a transpupillary view of the fundus was not possible. STUDY DESIGN A retrospective interventional case series. METHODS The main outcomes measured were postoperative anatomic status of the retina and subjective improvement of vision. RESULTS Postoperative reattachment of the retina and subjective improvement of vision were achieved in all 4 eyes. CONCLUSION Twenty five-gauge endoscopic vitrectomy provides a clear view making it possible conduct pars plana vitrectomy in order to reattach the retina in cases of proliferative vitreoretinopathy with severe corneal opacity.
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Affiliation(s)
- Mihori Kita
- Department of Ophthalmology, National Organization Kyoto Medical Center, 1-1 Mukouhata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan.
| | - Yukiko Fujii
- Department of Ophthalmology, National Organization Kyoto Medical Center, 1-1 Mukouhata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
| | - Sachiyo Hama
- Department of Ophthalmology, National Organization Kyoto Medical Center, 1-1 Mukouhata-cho, Fukakusa, Fushimi-ku, Kyoto, 612-8555, Japan
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Kita M, Mori Y, Hama S. Hybrid wide-angle viewing-endoscopic vitrectomy using a 3D visualization system. Clin Ophthalmol 2018; 12:313-317. [PMID: 29491704 PMCID: PMC5815505 DOI: 10.2147/opth.s156497] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose To introduce a hybrid wide-angle viewing-endoscopic vitrectomy, which we have reported, using a 3D visualization system developed recently. Subjects and methods We report a single center, retrospective, consecutive surgical case series of 113 eyes that underwent 25 G vitrectomy (rhegmatogenous retinal detachment or proliferative vitreoretinopathy, 49 eyes; epiretinal membrane, 18 eyes; proliferative diabetic retinopathy, 17 eyes; vitreous opacity or vitreous hemorrhage, 11 eyes; macular hole, 11 eyes; vitreomacular traction syndrome, 4 eyes; and luxation of intraocular lens, 3 eyes). Results This system was successfully used to perform hybrid vitrectomy in the difficult cases, such as proliferative vitreoretinopathy and proliferative diabetic retinopathy. Conclusion Hybrid wide-angle viewing-endoscopic vitrectomy using a 3D visualization system appears to be a valuable and promising method for managing various types of vitreo-retinal disease.
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Affiliation(s)
- Mihori Kita
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Yuki Mori
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
| | - Sachiyo Hama
- Department of Ophthalmology, National Organization Kyoto Medical Center, Kyoto, Japan
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Yokoyama S, Kojima T, Mori T, Matsuda T, Sato H, Yoshida N, Kaga T, Smith RT, Ichikawa K. Clinical outcomes of endoscope-assisted vitrectomy for treatment of rhegmatogenous retinal detachment. Clin Ophthalmol 2017; 11:2003-2010. [PMID: 29180845 PMCID: PMC5694206 DOI: 10.2147/opth.s147690] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Summary We evaluated the clinical outcomes for ophthalmic endoscope-assisted vitrectomy in consecutive patients with uncomplicated rhegmatogenous retinal detachment (RRD). The primary success rate was 98.4% (125/127) without performing a posterior drainage retinotomy or using perfluorocarbon liquids (PFCL) for subretinal fluid drainage. Purpose To investigate the clinical outcomes of endoscope-assisted vitrectomy in patients with uncomplicated RRD. Methods We examined 127 eyes from consecutive patients who underwent repair of RRD by 23- or 25-gauge endoscope-assisted vitrectomy, with a minimum follow-up of 3 months. Eyes with the following criteria were excluded: Giant retinal tears, grade C proliferative vitreoretinopathy, dense vitreous hemorrhage, retinal detachment secondary to other ocular diseases, and prior retinal or vitreous surgery. All cases underwent subretinal fluid drainage, endolaser photocoagulation and fundus inspection were performed under ophthalmic endoscopic observation. Success rate, visual acuity, surgery time and complications were evaluated. Results Primary and final success rate was 98.4% (125/127) and 100% (127/127), respectively, Surgery time was 59.6±26.3 minutes. The best-corrected visual acuity significantly improved from 20/100 to 20/20 (P<0.0001). There were 2 cases (1.6%) of creation of a peripheral drainage retinotomy and 4 cases (3.1%) of using PFCL to suppress movement of the detached retina, but there were no cases of creation of a posterior drainage retinotomy or using PFCL for subretinal fluid drainage. There was 1 case of presumed endophthalmitis after surgery. There were 12 hypotonous cases at postoperative day 1 and one of them needed additional scleral sutures at postoperative day 4 for prolonged hypotony. Conclusion The present study demonstrated the efficacy of endoscope-assisted vitrectomy for patients with uncomplicated RRD. To perform endoscope-assisted vitrectomy safely, sufficient closure of sclerotomies is necessary at the end of surgery.
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Affiliation(s)
- Sho Yokoyama
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Takashi Kojima
- Department of Ophthalmology, Keio University School of Medicine, Tokyo, Japan
| | - Toshio Mori
- Department of Ophthalmology, Iida Municipal Hospital, Iida, Japan
| | - Taisuke Matsuda
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - Hiroyuki Sato
- Department of Ophthalmology, Iida Municipal Hospital, Iida, Japan
| | - Norihiko Yoshida
- Department of Ophthalmology, Japanese Red Cross Gifu Hospital, Gifu, Japan
| | - Tatsushi Kaga
- Department of Ophthalmology, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan
| | - R Theodore Smith
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
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Kita M. Endoscope-assisted vitrectomy. World J Ophthalmol 2014; 4:52-55. [DOI: 10.5318/wjo.v4.i3.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 05/16/2014] [Accepted: 06/11/2014] [Indexed: 02/06/2023] Open
Abstract
Ocular endoscopes enable ophthalmologists to observe any part of the retina without any limitations, including those caused by corneal opacities, the rim of the intraocular lens, cortical remnants, capsular opacities, a small pupil, and vitreous opacities. Moreover, ocular endoscopes enable the management of peripheral lesions without scleral indentation and are compatible with microincision vitrectomy surgery. The enlarged view under the endoscope, as obtained by drawing towards the lesion, appears to be another advantage. Rhegmatogenous retinal detachment with undetectable retinal breaks, trauma, endophthalmitis, scleral wounds with incarceration of the vitreous, and microcornea are indications for endoscopic vitrectomy. The combination of endoscopy and a wide-angle viewing system could compensate for the deficiencies of each technique and achieve more effective and safer surgical maneuvers. Endoscopy skills appear to be a great advantage for vitreoretinal surgeons; however, because endoscopies require a learning curve, becoming familiar with the handling of the endoscope through step-by-step learning is necessary.
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Abstract
Vitreoretinal surgery has recently undergone remarkable developments. The introduction of micro-incision vitrectomy surgery using 25- and 23-gauge techniques has led to minimally invasive, faster, safer, and more accurate surgeries. Similarly, intraocular illumination and observation systems have advanced from light pipes to chandelier illumination, slit illumination, wide-angle viewing systems, and intraocular endoscopes. Compared to observation via the cornea and optic media, vitreous surgery using an endoscope is extremely useful, as the endoscope is inserted directly into the eye, circumventing the difficulties of corneal clouding and small pupil diameters. Furthermore, there are no blind spots after surgery. We here discuss the advantages of intraocular endoscope use, the current state of endoscopy-guided vitreoretinal surgery, and its future prospects.
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Affiliation(s)
- Shinichi Kawashima
- Department of Ophthalmology, School of Medicine, Tsurumi University, 2-1-3 Tsurumi Tsurumi-ku, Yokohama-shi, Kanagawa, 2308501, Japan
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