Instrumentation, imaging advances make retina surgery safer

Take home

For retinal surgery, the latest generation of instrumentation is anticipated to be accompanied by markedly improved fluidics, precision, and faster patient recovery.

By Lynda Charters; Reviewed by Pravin U. Dugel, MD, and Michael S. Ip, MD

The biggest advance over the past year, according to Pravin Dugel, MD, is that surgeons now have the ability to operate at a faster cutting rate with smaller-gauge instrumentation.

“The faster cutting rate of about 5,000 cuts per minute reduces the amount of traction on the retina and presumably makes removal of the vitreous safer. Cut rates as high as 7,500 cuts per minute, and even faster, are now possible. The smaller gauge allows for a smaller sphere of influence, making tissue removal more accurate and precise,” Dr. Dugel, Managing Partner, Retinal Consultants of Arizona, Phoenix and Clinical Professor of ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles, stated.

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Over the past years, retinal instrumentation has evolved gradually from 20 gauge to the current 27 gauge. The latest generation of instrument should be accompanied by markedly improved fluidics, precision, and faster patient recovery, all of which is very exciting, he explained.

Michael Ip, MD, who is associate professor, Department of Ophthalmology and Visual Sciences, University of Wisconsin, Madison, also applauds the smaller-gauge instrumentation for vitreoretinal surgery, but pointed out that the smallest gauge instrumentation, i.e., 27 gauge, is not yet widely used.

“I anticipate that with time we will gain experience with 27-gauge instrument and it may then take on a wider utilization,” he said.

The faster cut rates and decreased gauge size are available in a few vitrectomy systems, i.e., VersaVit from Synergetics, the Constellation Vision System from Alcon, and the Stellaris system from Bausch + Lomb.

Dr. Ip described the valved cannula as an important surgical aid for retinal surgeons that enhances the efficiency of vitrectomy.

“The development of valved cannulas has been very useful and in my hands has led to more stable IOP levels and decreased rates of hypotony in cases in which an open trocar is used,” he commented.

Upcoming technology

Dr. Dugel sees greatly improved retinal visualization on the horizon.

“Our visualization lags behind our mechanical abilities,” he said.

An example of this, he pointed out, is the gradual phase out of surgical microscopes over the next 5 to 6 years.

“I believe that we will be using digital imaging with heads-up display. That is how I currently perform all my surgeries,” he noted.

He also believes that over the next few years, surgeons will have the ability to use digitized images and then manipulate those images in order to enhance certain tissues of interest, to use multimedia, and to more accurately view the tissue being dissected.

Pravin U. Dugel, MD

E: pdugel@gmail.com

Dr. Dugel is a consultant to Alcon Laboratories, Novartis, Acucela, Allergan, Alimera, Genentech and is a consultant to and a minor shareholder of Ophthotech and Aerpio.

Michael S. Ip, MD

E: msip@wisc.edu

Dr. Ip has no financial interest in any aspect of this report.