Wide-angle viewing lens fogging: solving a common problem in vitreoretinal surgery
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LETTER TO THE EDITOR
Wide-angle viewing lens fogging: solving a common problem in vitreoretinal surgery Giuseppe Demarinis 1 & Filippo Tatti 1 & Enrico Peiretti 1,2 Received: 26 September 2020 / Revised: 2 November 2020 / Accepted: 6 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, Pars plana vitrectomy is one of the most important surgical techniques for the treatment of several vitreoretinal diseases [1]. Vitrectomy is performed using an operating microscope with a contact lens or a noncontact wide-angle viewing system (WAVs). The latter consists in a noncontact lens, in close proximity to the eye, such as a binocular indirect ophthalmomicroscope (BIOM, Oculus Surgical), RESIGHT (Carl Zeiss Meditec AG), or the EIBOS wideangle viewing system (Möller-Wedel, Wedel, Germany) [2–4]. Despite allowing a better visualization through optic media opacities and a much wider view of the fundus, the fogging of the noncontact lens during surgery still represents an important impairment for surgeon’s performance [3, 4] (Fig. 1a). A very good compromise is a panoramic viewing system made up of two components: an indirect ophthalmoscopy lens system and a stereo-reinverter prism system. The lens system consists of a contact corneal lens and a second biconvex aspherical lens that give several advantages such as distortion-free, large view, and minimal optical irregularities of the corneal surface. Furthermore, the airtight plastic lens holder allows a fixed distance between the two lens and prevents fogging of the lens [5]. Condensation forms when the temperature of an object is at or below the dew point temperature of the air surrounding the object [6]. In the vitreoretinal surgery field, it is due to the discrepancy in temperature between the noncontact lens and the ocular surface.
* Enrico Peiretti [email protected] 1
Department of Surgical Sciences, Eye Clinic, University of Cagliari, Via Ospedale 48, 09124 Cagliari, Italy
2
Clinica Oculistica, San Giovanni di Dio Hospital, Azienda Ospedaliera Universitaria di Cagliari, Cagliari, Italy
The humidity of eye structures is not constant during all steps of vitreoretinal surgery. Eter et al. showed that fluid-air exchange with dry air leads to loss of more moisture than humidified air from retinal tissue into the vitreous cavity, increasing visual field defects [7]. To assess the optimal condition for preventing condensation of objective lens, an experimental study was done by Lee et al. [8]. These authors explored the effectiveness of the corneal surface coating with ophthalmic viscoelastic devices (OVDs) and different lengths of lens soaking in warm saline. OVD coating on the corneal surface showed no difference on condensation, while soaking the noncontact lens in warm saline could extend the time to condensation, but only for a few minutes. Different strategies have been proposed to overcome this problem for a longer period of time. Gale et al. [9] reported a technique consisting of keeping the lens in sterile water at 125 °F (52 °C
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