While use of the endoscope is widespread, there are still surgeons who feel the microscope is sufficient. However, the increased visualization that the endoscope provides is an invaluable tool that can significantly improve outcomes in a variety of cases, particularly retinal surgeries.
While the microscope has limited range, the endoscope allows for enhanced visualization of anterior structures that are not usually visible.
Laser endoscopes perform three main functions—they provide light, image, and laser. Rather than the 30º cone of light possible with a microscope, the endoscope provides a 120º to 140º lighted field that enables the surgeon to see anything within the eye. The endoscope also comes as 23-gauge, so can be used with 23-gauge cannula systems.
Conversely, the microscope only allows for top-to-bottom imaging. In the periphery it is difficult, or impossible, to see. As a great deal of pathology may lie within that peripheral zone, there is a much greater risk of missing outlying pathology.
There are also a variety of issues that may block imaging when performing a vitrectomy, such as a cloudy cornea, small pupil, cataracts, blood or opacities, or condensation on a lens implant. With an endoscope, none of this is a problem.
The microscope is indispensable, but the endoscope provides a great deal of versatility, especially with retinal diseases. When performing procedures, there will come a point when the retinal periphery is no longer visible through the BIOM.
The endoscope can then be placed so that every hole and degenerative spot in the retinal periphery is visible, allowing the surgeon to monitor the surgery and deliver laser to parts of the eye that are not usually visible. Using the endoscope can improve surgical skills and allow the performance of maneuvers in a wide variety of “every-day” cases that would take more time or would be difficult or impossible to complete.