[Dr. Norihiko Yoshida] Vitreous retinal surgery

This time, I will talk about the retinal and vitreous surgery that I am in charge of.

First, let me briefly explain how we see things.
Light enters the eye through the pupil, passes through the vitreous humor that fills the inside of the eyeball, and then converges on the retina at the back.
The retina converts the light it receives into electrical signals and sends that information to the brain.
And when the brain perceives images as vision, people are able to "see" things.

The vitreous and retina can develop problems due to aging or disease.
For example, there is vitreous hemorrhage, in which the retina bleeds and accumulates inside the eyeball, and retinal detachment, in which the retina detaches from the wall of the eyeball.
If these conditions progress, they can lead to irreversible vision impairment or blindness, necessitating surgical treatment.
In such cases, vitreous surgery is performed.

Vitrectomy is a procedure in which thin instruments are inserted into the eye to remove the vitreous body, remove bleeding, and attach the retina.
First, we need to look inside the eye.

So, do you know how to actually see inside the eye?
The surgeon looks inside the patient's eye through the pupil, just like looking through a peephole.
However, if your pupils are small (your peephole is small), it can be very difficult to see. What should you do in such a case?

Recently, there is a very useful machine called a wide-angle fundus observation system, which allows you to observe a wide area inside the eye through a small peephole and a special lens.
With excellent image quality and good visibility, this system is essential for performing highly precise surgery.
However, even if this system is used, it is not possible to observe the back of the iris, etc. There are "blind spots" that cannot be seen with this system alone.

What should you do in such a case?
Have you ever heard of the term "endoscope", such as gastroscope or colonoscope?

This is a machine with a camera attached to the end of a thin tube that is inserted into the digestive tract to directly observe the inner walls of the stomach and intestines.It is approximately 5 to 10 mm thick.
Endoscopes are used not only in gastroenterology but also in ophthalmology. They are inserted into the eyeball for observation, so they are 0.4 to 0.5 mm in diameter. Half of 1 mm! They are very thin.
This is useful because it is a direct observation and there are no "blind spots" as opposed to observing through the pupil.
However, because ophthalmic endoscopy requires special techniques, unfortunately it is not widely used.

We utilize the advantages of both the ophthalmoscope and the wide-angle fundus observation system to perform surgery.
This is the unique feature of vitreous surgery performed at Nagoya Eye Clinic.

I talked about the "observation system" used in vitreous surgery, which is my specialty, the retina.