FOCUS ON …
A System With a View
LESLIE GOLDBERG, ASSOCIATE EDITOR
Volk's Optiflex is a precision maneuvering and control instrument for the positioning of non-contact lenses used during vitreoretinal surgical procedures.
The system mechanically attaches beneath the optical pathway of the surgical microscope and is designed to position a lens above the patient's eye, in alignment with the microscope optical pathway. This lens is positioned close to the patient's eye (Figure 1), presenting a crisply focused pan-retinal image.
Figure 1. Image displaying the closeness of the lens to the patient's eye.
Martin Charles, MD, in private practice in Argentina, likes the freedom provided by the Optiflex, as it allows him to work without assistance. Dr. Charles says that it is easier to conduct scleral depressions than with contact lenses and delivers very good image quality.
He says that the system is very simple to attach, and is fully auto-clavable. "It has an excellent depth of field with no distortion in the periphery," says Dr. Charles. "It has very good image quality during air-fluid exchange procedures (Figure 2). And, as it is a noncontact method, it works well in eyes with open-globe injuries, for example when extracting large intraocular foreign bodies."
Figure 2. Image taken during air-fluid exchange, showing impressive clarity.
Dr. Charles provides surgeons with 2 tips when using the Optiflex: First, it is very important to moisten the cornea with a viscoelastic solution. It gives you approximately 10 minutes of good corneal lubrication and the fundus image quality is much better than that obtained with balanced salt solution. Second, we do not have problems of lenses fogging, but if somebody has it, I recommend turning the air conditioning on, and having the surgical drape well in place to avoid the breath of the patient going through any detachment of the surgical drape with the skin.
Marc de Smet, MD, PhD, professor at the Academic Medical Center, University of Amsterdam, has been using the system for a year. He says that the Optiflex provides superior optics out to the periphery, similar to contact wide-field lenses. "In an aphake, it is possible to see beyond the ora. In a phakic patient, a slight peripheral indentation can bring the ora into view. The optics ensure a very sharp clear image."
Dr. de Smet especially likes the wide-angle lens and its optics. "The fact that it has a small footprint next to the eye is also a useful feature as there is little interference with the surgical field, and there is easy access to the eye. It is a flexible system that allows for an easy fine focus should the depth of focus change with say an air-fluid exchange. This can rapidly be adjusted with either a motorized system or by hand," says Dr. de Smet.
Dr. de Smet uses both lenses. "For fine macular work, I still prefer a contact lens; for proliferative diabetics the high-mag lens gives a great view of the posterior pole, for all other cases and also core vitrectomies, I prefer the wide-field lens.
"The optics make this a superb lens. Also, the flexibility of the design allows you to get superior images under conditions that were not possible before, but it requires a good alignment at the onset of the case. The eye needs to be centered in the middle of the field. From then on, imaging even to the far periphery should be possible with a slight motion of the eye in any given direction," says Dr. de Smet. RP
For more information on Volk's Optiflex system, contact Tim Warrell at firstname.lastname@example.org or phone him at (440) 510-0745.