23-Gauge endoscopic vitrectomy

Abstract

Vitreoretinal diseases are exemplified by a wide spectrum of complexities. The purpose of this review is to highlight the potential role of endoscopic vitrectomy in modern microincision vitreoretinal surgery. This is related to the clinically relevant optical properties that are exclusive to endoscopy, namely the ability to bypass anterior segment opacities, visualization of difficult-to-access regions of the retina, the unique surgeon's perspective, and the use of reflected (coaxial) versus transmitted (dissociated) illumination. Indications for endoscopy include posterior pathology with limited-to-no view secondary to anterior segment pathology, difficult-to-assess retroirideal pathologies involving the sclerotomy, pars plana, pars plicata, ciliary sulcus, ciliary body, or peripheral lens, and complex anterior retinal detachments, particularly in pediatric vitreoretinopathies and anterior proliferation. The recent advent of the 23-gauge endoscope significantly increases the utility of endoscopic vitrectomy, making it a potentially important part of the surgical armamentarium alongside conventional viewing systems.