Illumination systems in vitreoretinal surgery: a comparative review of safety and efficacy
- 1Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, 20072 Italy
- 2IRCCS Humanitas Research Hospital, Via Alessandro Manzoni, 56, Rozzano, Milano 20089 Italy
- 3Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy
Abstract
Background: Endoillumination is essential in modern vitreoretinal surgery, enabling visualization during peripheral vitreous shaving, retinal detachment repair, and other bimanual maneuvers. Chandelier illumination provides a stable wide-field light source through a separate port and should be regarded as an adjunct to conventional handheld fiber-optic endoillumination rather than as a replacement. This narrative review compares handheld, chandelier, and emerging LED-based illumination systems, focusing on surgical utility, visualization, illumination geometry, and retinal light-exposure considerations.
Main text: A PubMed literature search was conducted for studies published between 1990 and April 2026. After screening 401 records and evaluating 72 full-text articles, 24 studies were included in the qualitative synthesis. These comprised in vitro investigations on retinal pigment epithelial cells, ex vivo porcine-eye irradiance measurements, prospective clinical series, and one randomized controlled trial. Across the available evidence, the most consistent safety advantage of chandelier illumination was related to delivery geometry. By increasing the working distance from the retina, chandelier systems markedly prolong retinal threshold exposure time compared with handheld endoillumination probes, largely in accordance with the inverse-square law. LED-based systems demonstrated variable safety profiles depending on spectral output, with some devices showing prominent short-wavelength peaks and others exhibiting lower blue-light fractions when compared to xenon sources. Spectral filtering, particularly amber filtering during dye-assisted procedures, further reduced photochemical hazard. Three-dimensional digital visualization systems also reduce the level of physical intraocular illumination required from conventional lighting systems while maintaining adequate surgical visualization. Additional emerging technologies, including micro-LED chip-on-tip probes, transscleral illumination, omnidirectional diffusers, and portable LED devices, suggest a broader transition toward fiber-free or fiber-optimized illumination platforms.
Conclusions: Chandelier-based LED illumination systems appear to offer a versatile and generally safer addition to traditional wired endoilluminators. Their clinical value lies in improving peripheral visualization and facilitating complex bimanual maneuvers. Safety advantages are mainly related to illumination geometry, working distance, light distribution, and reduced need for repeated handheld probe manipulation. Nevertheless, retinal safety depends on the combined effects of emission spectrum, delivery geometry, intraocular distance, exposure duration, spectral filtering, surgical technique, and visualization system.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40942-026-00918-y.
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BibTeX
@article{lupo2026illumination,
title = {{Illumination systems in vitreoretinal surgery: a comparative review of safety and efficacy}},
author = {Massimo Lupo and Sergio Lebet and Andrea Rescalli and Simone Micalizzi and Andrea Govetto and Paolo Oliva and Mario R. Romano},
journal = {International Journal of Retina and Vitreous},
year = {2026},
month = aug,
doi = {10.1186/s40942-026-00918-y},
url = {https://doi.org/10.1186/s40942-026-00918-y},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Illumination systems in vitreoretinal surgery: a comparative review of safety and efficacy
AU - Massimo Lupo
AU - Sergio Lebet
AU - Andrea Rescalli
AU - Simone Micalizzi
AU - Andrea Govetto
AU - Paolo Oliva
AU - Mario R. Romano
PY - 2026
DA - 2026/08/01
JO - International Journal of Retina and Vitreous
DO - 10.1186/s40942-026-00918-y
UR - https://doi.org/10.1186/s40942-026-00918-y
AB - Background: Endoillumination is essential in modern vitreoretinal surgery, enabling visualization during peripheral vitreous shaving, retinal detachment repair, and other bimanual maneuvers. Chandelier illumination provides a stable wide-field light source through a separate port and should be regarded as an adjunct to conventional handheld fiber-optic endoillumination rather than as a replacement. This narrative review compares handheld, chandelier, and emerging LED-based illumination systems, focusing on surgical utility, visualization, illumination geometry, and retinal light-exposure considerations. Main text: A PubMed literature search was conducted for studies published between 1990 and April 2026. After screening 401 records and evaluating 72 full-text articles, 24 studies were included in the qualitative synthesis. These comprised in vitro investigations on retinal pigment epithelial cells, ex vivo porcine-eye irradiance measurements, prospective clinical series, and one randomized controlled trial. Across the available evidence, the most consistent safety advantage of chandelier illumination was related to delivery geometry. By increasing the working distance from the retina, chandelier systems markedly prolong retinal threshold exposure time compared with handheld endoillumination probes, largely in accordance with the inverse-square law. LED-based systems demonstrated variable safety profiles depending on spectral output, with some devices showing prominent short-wavelength peaks and others exhibiting lower blue-light fractions when compared to xenon sources. Spectral filtering, particularly amber filtering during dye-assisted procedures, further reduced photochemical hazard. Three-dimensional digital visualization systems also reduce the level of physical intraocular illumination required from conventional lighting systems while maintaining adequate surgical visualization. Additional emerging technologies, including micro-LED chip-on-tip probes, transscleral illumination, omnidirectional diffusers, and portable LED devices, suggest a broader transition toward fiber-free or fiber-optimized illumination platforms. Conclusions: Chandelier-based LED illumination systems appear to offer a versatile and generally safer addition to traditional wired endoilluminators. Their clinical value lies in improving peripheral visualization and facilitating complex bimanual maneuvers. Safety advantages are mainly related to illumination geometry, working distance, light distribution, and reduced need for repeated handheld probe manipulation. Nevertheless, retinal safety depends on the combined effects of emission spectrum, delivery geometry, intraocular distance, exposure duration, spectral filtering, surgical technique, and visualization system. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40942-026-00918-y.
SN - 2056-9920
ER -