New instruments, devices improve safety and speed in vitreoretinal surgery

Take-home message: David R. Chow, MD, provides an overview of new technological advancements for the vitreoretinal surgeon.

Reviewed by David R. Chow, MD

Toronto-Several product launches in recent months are expanding the vitreoretinal surgical armamentarium. These include new vitrectomy platforms, probes, chandeliers, cannulas, surgical lenses, forceps, and loops. David R. Chow, MD, highlights some of these many innovations in this technology overview.

The EVA PhacoVitrectomy System (DORC) has advanced features, the backbone of which, according to Dr. Chow, is its two-dimensional cutter. The high-speed vitrector probe is capable of 16,000 cuts/minute. The cutter comes with an optional handle extension and has a double cut and double aspiration with each duty cycle-due to its unique inner sleeve. This system recently received FDA 510(k) clearance.

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“In the laboratory, in balanced saline solution and artificial vitreous, the cutter creates aspirational flow rates that remain constant and are independent of the cut rate, due to its 92% duty cycle,” said Dr. Chow, assistant professor of ophthalmology, University of Toronto, St. Michael’s Hospital, Toronto.

He explained the increased safety associated with this system as a result of the reduced traction on the surrounding tissue with double cuts and no surges in turbulence.

Constellation CR4 Software upgrade (Alcon) is another recent product to enter the market. The software has a number of phaco and vitreoretinal enhancements.

“The software upgrade supports a 10,000 cut/minute vitrector probe (Advanced Ultravit Vitrectomy Probe), the Autosert IOL injector, Ozil IP functionality for cataract surgery, and various usability enhancements,” Dr. Chow said.

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The Advanced Ultravit Vitrectomy Probe, in addition to its high-cut rate, has a beveled tip that allows the instrument to come into closer proximity to the retina.

The latest iteration of the Versavit 2.0 Platform (Synergetics) offers some new surgical features for surgeons including reflux, increased vacuum levels up to 600 mm Hg, and a better port entry system.

Single use sterile lens

Sensor Medical Technology recently introduced a line of single-use sterile lens for use in the office and operating room.

“These provide exceptional optics at a low cost,” Dr. Chow said. The lenses include a 20-D wide-field lens, available in a box of 10 lenses for $130, are excellent for use in patients with small pupils; wide-field lenses at a cost of $285 for a box of 10 lenses surgical contact lenses; surgical lenses available in boxes of 10 lenses with costs ranging from $174 to $214.

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The Hassan Tornambe Contact Lens (Insight Instruments) is a single-use plano-concave lens with a 36° field of view. Dr. Chow described that it has a unique absorbent foam ring with supporting lens for increased stability, making it ideal for use without an assistant.

Improvue (Oculus Instruments) is a corneal wetting agent made of preservative-free 1.7% hypromellose, a highly viscous polymer. Packaged in a 2-ml preloaded syringe, this product has a duration of action that lasts about 20 minutes.

New chandeliers include a 27-gauge Vivid Chandelier (Synergetics), which has a two-step cannula design. Bausch + Lomb has introduced the 23-gauge Adjustable Chandelier with a slider for the Stellaris PC. This chandelier has a friction fit for secure placement over the cannula. The slider is placed near the surgical field to allow titration of the intensity of the chandelier, Dr. Chow said.

Alcon developed the Finesse Flex Loop, which is a curved Nitinol loop with 82 tines. The instrument’s concave shape retards penetration proportional to the amount of indentation; the design allows no more than 85% penetration into the internal limiting membrane (ILM). The loop is adjustable in order to change the stiffness. The loop has the potential to be used for IOL retrieval and hyaloid removal, he pointed out.

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An ILM forceps with a new Eckardt tip design is available from Vitreq. Dr. Chow explained that the tip has a wider grasping platform for reduced membrane tearing, a shorter tip for stronger grasping force, and a tip length that is optimized to balance visualization and tractive force. It is available in gauge sizes ranging from 20 to 27.

A new forceps, the Kamei Sweeper Forceps (Katalyst Surgical) has as its main feature, actuation that results in the movement of only one blade.

“This forceps is thought to be ideal for young surgeons,” he said. “Interestingly, the concept for the design of this instrument came from the traditional use of Japanese chopsticks.”

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Katalyst Surgical also introduced the Invisible Forceps, which has tips designed to allow easier retinal visualization.

A new cannula from MedOne, the Dualbore Sideflo Cannula, has an all-metal design for easier insertion of valved cannulas, a filled hub design to reduce air bubbles, a side port for fluid injection for increased safety, and multiple fluid egress vents for improved outflow and therefore faster relief of pressure. MedOne also introduced the 27-gauge fluid injector cannula that facilitates injection of 5 millimeters of 1,000 centistoke oil in 40 seconds at 80 pounds per second.

New directional laser probes have entered the market. The Vektor Articulated Illuminated Laser Probe (Alcon) allows access to the anterior retina. The Revolver Steerable Laser Probe (Katalyst) has a reusable handle and a disposable fiber.

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New disposable backflush needles include one from Katalyst that has a T-tube for easy access into valved cannulas. DORC also designed a backflush needle with a smoother sliding mechanism.

Retractable diamond-dusted membrane scrapers were made by DORC and Synergetics Tano DMS for ease of insertion into valved cannulas.

The El Rayes Suprachoroidal Catheter from MedOne has been released for use during scleral buckling.

Two in-office procedure systems have been introduced, one from Haag Streit, the I-OPS, is a modular instrument tray that mounts on to most instrument trays to improve efficiency during injections. The second one is from the Medical College of Wisconsin in collaboration with Katalyst, the Rapid Access Virtual Injection System. The system is a titanium autoclavable device that functions as a lid speculum and measuring device.

Finally, iPhone-based retinal cameras offer downloadable apps and wide fields of view.

David R. Chow, MD

E: davidrchow@me.com

This article was adapted from Dr. Chow’s presentation during Retina Subspecialty Day at the 2015 meeting of the American Academy of Ophthalmology. Dr. Chow is a consultant to Alcon Laboratories, Allergan, Bayer Healthcare Pharmaceuticals, DORC International, Katalyst, Optovue, and Synergetics.