Twenty-Three–gauge Hypersonic Vitrectomy

Abstract

Purpose: To evaluate the safety, effectiveness, and the best parameters setup of hypersonic vitrectomy.Methods: A prospective, multicentric, interventional study on 50 eyes that had undergone hypersonic vitrectomy because of various vitreoretinal diseases. We primarily assessed the effectiveness of vitreous removal, intraoperative complications, and surgical setup. Secondarily, we evaluated single-surgery anatomical success and postoperative best-corrected visual acuity.Results: Intraoperative complications occurred in 5 eyes (10%), whereas technical problems were detected in 23 eyes (46%), resulting in conversion to guillotine vitrectomy in 15 cases. The most common finding related to the technical problems was an inadequate vitreous liquefaction with the formation of vitreous strands and consequent inadequate vitreous outflow, sometimes complicated by vitreous incarceration in the vitrectomy probe. The best settings were considered a stroke of 60 mm and vacuum of 40 mmHg for both core and peripheral vitrectomy. At 3-month follow-up, primary anatomical success was achieved in 49 eyes (98%) and the mean best-corrected visual acuity overall improved. Conclusion:The availability of hypersonic vitrectomy in the current surgical practice opens a new era in vitreoretinal surgery. Despite the potential advantages in fluidics, the performance of hypersonic vitrectomy system needs to be further optimized, mainly for the occurrence of inadequate vitreous liquefaction and vitreous strands formation.

Safety and Efficacy of Hypersonic Vitrectomy for Retinal Reattachment Surgery in Proliferative Vitreoretinopathies

“…Stanga et al reported in the first clinical cases that vitreous strands were present in the majority of cases. 19 This was better managed in Blinder’s and Romano’s study, which reported difficulties in cutting the vitreous and the presence of vitreous strands in only 13% 21 respectively in 10% 22 of cases. With ongoing further clinical studies and machine parameter adaptations, this issue may be minimized.…”

“…Prior research on the use of hypersonic vitrectomy with Vitesse has shown similar promising results regarding the safety and efficiency of the device. 19 , 21 , 22 Stanga et al 19 published the first human study using Vitesse on 20 patient eyes in India. In this study, surgeons were able to successfully perform peripheral vitrectomy in 18 of 20 patient eyes using hypersonic vitrectomy.…”

“…This study reported that in 9 of 64 cases, vitrectomy could not be completed entirely using the Vitesse device and that the surgeon switched to a pneumatic guillotine cutter during the procedure. Romano et al 22 performed a prospective, multicentric, interventional study on 50 eyes using hypersonic vitrectomy. In this study, 70% of the cases could be finished using hypersonic energy exclusively, in 30% the vitrectomy was finished switching to a guillotine cutter.…”

“… 21 In Romano’s study two iatrogenic retinal breaks appeared. 22 Stanga et al performed no retinal reattachment surgeries with Vitesse and Blinder reported 23 cases. In this case, all retinal detachments could be successfully reattached with hypersonic vitrectomy and repeat PPV was required for recurrent retinal detachment in 2 patients.…”

Retinal and Corneal Changes Associated with Intraocular Silicone Oil Tamponade

“…These droplets, dispersed in the aqueous phase, can vary in size, penetrate into ocular tissues, and can be detected within retina, optic nerve, cornea, iris, trabecular meshwork and ciliary body [ 61 , 62 ]. Silicone oil emulsification is influenced by the properties of the SO itself (e.g., interfacial tension and viscosity) and a variety of additional factors, such as shear stresses generated at the SO–aqueous interface during saccadic eye movements [ 63 , 64 ], presence of encircling bands [ 63 ], concomitant intraoperative use of perfluorocarbon liquids [ 65 ], energy generated by intraocular instruments [ 66 , 67 ], and the presence of compounds acting as surfactant, e.g., LMWC [ 68 ] and endogenous molecules (e.g., blood components, lipids, proteins, etc.) [ 69 , 70 , 71 , 72 ].…”