Clinical Outcomes Of Beveled Tip, Ultra-High Speed, 25-Gauge Pars Plana Vitrectomy System

OBJECTIVE To report clinical outcomes of a 25-gauge, beveled-tip, 10000 cuts-per-minute (cpm) microincisional vitrectomy surgery (MIVS) system. METHODS Prospective case series of eyes undergoing primary pars plana vitrectomy (PPV) for common indications. Main outcome measures were: rate of achieving surgical objectives, operative time, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE). RESULTS Surgical objectives were achieved in all eyes. Mean total operative, core, shave and total vitrectomy times were 1891 ± 890, 204 ± 120, 330 ± 320, 534 ± 389 seconds, respectively. Mean number of surgical steps was 4.3 ± 1.5. Mean number of ancillary instruments used was 4.5 ± 1.9. Mean CDVA improved by 0.53 ± 0.56 logMAR units (P < 0.001) after 3 months. Postoperative AE included elevated IOP (8%), hypotony (6%), and re-detachment (2%). Majority (82%) had no postoperative discomfort. CONCLUSION Beveled-tip, 10000 cpm MIVS system effectively and safely performs common vitreoretinal procedures and may reduce operative time and ancillary instrumentation.

Comparison of 27-gauge and 25-gauge vitrectomy in the management of tractional retinal detachment secondary to proliferative diabetic retinopathy

Objective To compare surgical outcomes between 27 and 25-gauge vitrectomy in proliferative diabetic retinopathy (PDR) with tractional retinal detachment (TRD) Methods This retrospective study was conducted to compare the intraoperative status, operation time, use of instruments, endotamponade substance, wound suture number, and iatrogenic break, between 27 and 25-gauge vitrectomy in 43 eyes afflicted by PDR with TRD. The post-surgical results, best-corrected visual acuity, intraocular pressure, recurrent vitreous haemorrhage, and re-operation rate were regularly followed up for 6 months. Results Patients in the 25 and the 27-gauge groups did not differ significantly in terms of pre-surgical conditions, such as age, gender, pre-existing glaucoma, best-corrected visual acuity (BCVA) and the severity of their TRD. The mean operation time was 56.7 minutes in the 27-gauge group and 63.7 minutes in the 25-gauge group (p = 0.94). There is significantly less use of micro forceps in the 27-gauge group (p = 0.004). No difference between micro scissors and chandelier usage were noted; neither was their difference in iatrogenic retinal breaks. Significantly fewer wound sutures were noted in the 27-gauge group (p < 0.001). The post-operative results revealed no significant difference in ocular hypertension, hypotony, BCVA improvement, recurrent vitreous haemorrhage and re-operation rate. Conclusions The 27-gauge vitrectomy system offers comparable surgical outcomes in PDR with TRD. The 27-gauge vitrectomy system is suitable for complicated retinal surgery.

Comparison of modern high-speed vitrectomy systems and the advantages of using dual-bladed probes

Purpose This study analyzes the efficiency of different vitrectomy systems and compares single with double-bladed cutters. Methods The systems EVA™ (DORC), Constellation® Vision System (ALCON), megaTRON S4HPS (Geuder) and Stellaris® PC (Bausch and Lomb) were used. We chose 20G and 23G probes, since not all systems had switched to a smaller G at the time the study was conducted in 2016. Cut rates were varied in increments of 1000 cuts/min from 500 cpm to the system’s maximum and vacuum pressures were varied in increments of 100 mmHg, from 100 to 600 mmHg up to the individual system’s maximum. In this study water, egg white, Pluronic®−F127 gel and isolated porcine vitreous were used as models of human vitreous. The vitrectomy efficiency was calculated from the aspirated mass (g) within 30 s. The aperture of the different vitrectomy probes was filmed with a high-speed camera. Results The area under the curve analysis showed differences in efficiency between vitrectomy systems. For water, a reverse relationship between the aspirated mass and cut rate was shown. By contrast, for most systems aspirated egg white and porcine vitreous showed a non-linear increase or decrease for 4000 cpm and above. For all vitreous surrogates, EVA™’s double-bladed probe aspirated significantly (p < 0.001) more vitreous than its mono-bladed probe. Video recordings showed less vitreous traction for double- in contrast to single-bladed probes. Conclusion We can demonstrate differences in the efficiency of vitrectomy depending on the vitrectomy system used. Double-bladed probes were more efficient and probably safer than single-bladed probes.

Assessment of the fluid dynamic performance of a vitreous cutter

Vitreous cutters are surgical devices used during vitrectomy to remove the vitreous humor from the eye and replace it with tamponade fluids. The aim of the present work is to assess the performance of the EVA Phaco-vitrectomy System vitreous cutter (Dutch Ophthalmic Research Center (DORC) BV; Zuidland, The Netherlands) used with diff erent needle sizes and blade shapes. The analysis is based on laboratory measurements of fluid flow performed using the particle image velocimetry (PIV) technique.

Heads-Up Macular Surgery with a 27-Gauge Microincision Vitrectomy System and Minimal Illumination

Objective: We combined heads-up 3-dimensional (3D) 27-gauge microincision vitrectomy surgery (27GMIVS) with a very low-intensity illumination system. Methods: This study was based on a retrospective, interventional case series of 6 eyes of 6 patients with macular disease. All patients underwent heads-up 3D 27GMIVS and the power of the intraocular illuminator was set to its minimum level, 1% (approximately 0.1 lm), throughout the surgery. Results: We found that the procedure was easy when the heads-up 3D system was used, but not through the eyepiece of a microscope. All surgeries were successfully finished without any complications. Postoperative visual acuity was restored or maintained in all eyes during the follow-up period. Conclusion: Heads-up, 3D system-assisted 27GMIVS with minimal illumination enabled excellent intraoperative visualization of retinal tissues, caused minimal phototoxicity to the macular retinal cells, and might therefore represent the next step in the development of an ideal, minimally invasive method of treating macular disease.