3 University of South Florida, Tampa. 4 Bonn University, Germany. K. Peter Luloh has a financial interest in the Grin endoscope as a producer and developer. Our surgical technique and experience are reviewed. Adequate visualization to perform subretinal surgery without retinotomy is possible with the Grin endoscope.
Several problems remain to be solved.
These include bleeding into the choroid and subretinal compartments, maintenance of the subretinal space during the procedure, and iatrogenic breaks during hydraulic detachment of the retina. The Grin endoscope provides superior optical resolution to the pixel fiberoptic endoscope. Since the surgeon views the subretinal space through the operating microscope, visualization is limited by the clarity of the optical media and more importantly by the translucent detached retina and opaque serosanguinous subretinal fluid. Furthermore, manipulations are limited to single handed grip and rip motions which often tear the surrounding retinal pigment epithelium and enlarge the retinotomies. Micro-endoscopic viewing systems offer a solution for visualizing the subretinal space and choroid.