Surgical retina

1. Wide Angle Viewing Field Systems
in VR Surgery
Dr Rajvin Samuel Ponraj Fellowship Sankara Eye Hospital Pammal

2.  Vitreous Surgery requires the help of Special
devices to clearly visualize the Retina and
Vitreous.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

3. Contact Type :
 VPFS ( Vitreous Panfundoscope)
 CWF (Contact wide field System)
 AVIS (Advanced Visual Instrument system)
 ROLS (Reinverting Operating lens system)
- Clarivit
- HRX (Volk Optical)
 Non Contact Type :
- BIOM (Binocular IDO) – (Oculus)
- MERLIN –(Volk Optical )
- EIBOS (Erect Indirect Binocular IDO)-
- OFFISS (TOPCON)
- RESIGHT (Carl Zeiss) - Peyman –Wessels-
Landers
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

4. Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

5. Hand Held Irrigating Contact
lenses
 Neutralize High Convergence of Corneal
Curvature to focus on Retina , Vitreous.
3 types of Lenses:
- Plano concave lenses with a view of 20 degrees
- Biconcave lenses with view of 30 degrees
- Prism lenses with meridonial view of 60 degrees
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

6. Hands Free Contact Lens (Landers
System) OLIV-WF
 Hands free contact lenses were introduced by
Landers and co workers which were stabilized
onto the cornea with the help of a sewn-on limbal
ring (stainless steel )
 Too tight – corneal folds,break suture
midway of surgery
 Too loose- decentration of lens
 Bleeding can obscure view of surgeon.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

7.  Plano concave lens – core vitrectomy
 Landers biconcave lens – visualization in air filled
eye
(90 D Lens – 25 deg angle field)
 Machemers magnifying lens – surface details on
posterior pole (28-30 deg angle field)
 Peyman wide field lens –equatorial portion
 Tolentino 20 degree prism – periphery
 Tolentino 30 degree prism – extreme periphery
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

8.  Disadvantages:
- Limited field of view
- Peripheral Retina seen only with Indentation
- Lens alignment problems
-Air Bubble/ Blood film coming beneath Lens
System
-Poor visualization in Small pupils and Fluid –gas
exchange
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

9. Conventional Viewing System
 Advantages:
Lower Cost
Non – Inverted Image
Less learning curve for Surgeon
Excellent resolution
 Disadvantages :
View compromised with Corneal opacity, Lenticular
haze and Small pupils.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

10. OPTICS OF CONVENTIONAL
VITREOUS SURGERY
 A Plano-concave contact lens made of
polymethylmethacrylate
Refractive index of 1.488 and a concave
posterior surface radius of curvature of 7.7 mm is
used
Refractive power of the anterior surface
48.8 D to -14.5 D and the fundus is easily
visualized
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

11. Principle of Indirect Ophthalmoscopy
 To make the eye highly Myopic by placing a
strong Convex lens in front of it.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

12. Wide Angle Viewing Systems
 Contact and Non Contact
- Both provide Panaromic View up to Ora serrata
and enhances the safety and efficiency of Surgery
- Problems of High Cost
- Inverted image is unsuitable
- Bulky and long learning Curve
- Distortion of Anatomy interferes with Quality
of Fundus image.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

13. Wide Angle Viewing Systems
Contact Non Contact
Advantages
Image resolution and stereopsis
better
No intraoperative Corneal trauma
Eliminates corneal aberrations &
limits the number of reflecting
surfaces
Good view during Fluid air
exchange
Wider field of view- Less need of
Ocular rotation
Good view - small pupils and
irregular corneas
Disadvantages
Poor view in case of corneal or lens
opacity/ haze
Poorer image resolution and depth
perception
Chance of corneal deformation Learning curve - more
Change in IOPDr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

14. OPTICS OF CONVENTIONAL
CONTACT LENSES
 The first component (inferior lens) –acrylic
contact lens concave posterior surface. Power of
4 D.
 The second component (superior lens) -biconvex
aspherical image-forming, high refractive index
glass lens 0.5 mm anterior of the contact lens
element and an effective
power of 150 D in air.
 Real, inverted, aerial retinal image anterior to the
image forming lens system.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

15. Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

16. Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

17. Optics in Air Filled Eye
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

18.  Posterior surface of the lens becomes strongly
refractive
(64 D)
 Total refractive power of the eye increases from
59 to 102 D
 Field of View is 130 deg.
 Microscope eye piece should be moved closer to
Patients eyes.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

19. Oculus BIOM & SDI-Stereoscopic
Diagonal Inverter.
Requires SDI to invert the
indirect
image from BIOM to a
conventional upright image
(Internalised Prismatic system
Foot pedalled & Automatic )
(Near Zero Light Escape)
Easily adaptable to
microscopes,
sterilised easily
Field of view = 70, 90, 110
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

20. Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

21. Peyman-Wessels-Landers 132 D
Upright Vitrectomy Lens
 Wide field Upright images without invertor
(Internalised prisms).
 Operating Table mounted
system ,Can be attached to
any microscope
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

22.  The OSVS-U132-2 is a non-contact vitrectomy
lens system designed with a flexible arm for
positioning wide-angle lenses, which easily
swings in and out of the surgical field. The OSVS
(clamps) attaches to the wrist rest or surgical bed,
freeing the surgeon and assistant to perform
tasks other than holding the lens. When used with
the Ocular Peyman-Wessels-Landers 132 Diopter
Upright Vitrectomy Lens (OUV-132-2), the system
allows the surgeon to work in the vitreous with an
upright, non-reversed image under panoramic
viewing conditions
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

23. OFFISS- Topcon OMS-800
 Optical fibre free Intravitreal Surgery system
 Incorporated illumination , No need of Light probe
 Can perform Bimanual surgical techniques.
 Working distance is more ,hence less chance of lens
touching cornea.
 Higher cost as the whole system including the
microscope must be bought.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

24. EIBOS Erected Image Binocular
microscope
 Incorporates Inverter and
indirect systems in one piece.
Inverter cannot be used
independently.
 Incorporates Spring balanced
safety – elevation of the Unit
if Lens comes in contact with
the eye.
 Field of View = 100,125 degrees.
 90,132 D Lenses
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

25. Resight 700 from Carl Zeiss
 Can hold two lenses simultaneosuly
- 127 deg lens for Wide Angle field
- 60 deg lens for High resolution Macular lens
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

26. Contact Types
 VPFS ( Vitreous Panfundoscope)
 CWF (Contact wide field System)
 AVIS (Advanced Visual Instrument system)
 ROLS (Reinverting Operating lens system)
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

27. Vitreous Panfundoscope
 Modified Rodenstock panfundoscope
 Field of view = 130 – 150 deg
 Need of SDI. Inverted image.
 Easy introduction of instruments without
disturbing lens.
 Hand held stabilized and heavy compared to
other lenses.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

28. Contact Wide field lenses
 Inverted image , Need of SDI
 Field of View = 120-130 degree
 Held by handle or Standard lens ring
 Lighter and smaller than VPFL
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

29. Advanced Visual Instrument System
 AVI stereo inverter
 2 miniature contact lenses
 68 and 130 degree field of views
 Hand held by assistant or self retaining ring
 Smaller,lighter, allows easy manipulation of lens
 Allows visualization of fundus through small pupil
or air filled eye.
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal

30. Reinverting Operating Lens
System
 Single element reinverter prism design to correct the
inverted image.
 Super Macula lens -60 deg
 Mini Quad lenses -127 deg
 Mini Quad XL lenses – 134 deg
 Dyna – 156 deg
Dr Rajvin Samuel Ponraj Fellowship Sankara
Eye Hospital Pammal