High-Speed Surgical System May Reduce Pars Plana Vitrectomy Time

A 25-gauge, beveled-tip, ultra-high speed, microincisional vitrectomy surgery (MIVS) system can be used to safely and effectively perform common vitreoretinal (VR) procedures of varying complexity, according to research published in BMC Ophthalmology. The system may reduce operative times and need for ancillary instrumentation.

Investigators report the findings of a prospective case series of eyes undergoing primary pars plana vitrectomy (PPV) with a 25-gauge, beveled-tip, 10,000 cuts-per-minute MIVS system for common vitreoretinal indications.  

The main outcome measures of the study include the rate of achieving surgical objectives, operative times, number of surgical steps, use of ancillary instruments, corrected distance visual acuity (CDVA), and adverse events (AE).

Between April 24 and October 24, 2019, 50 eyes of 50 patients (mean age, 57.2 years; range, 16-84) underwent primary PPV. Patients’ baseline mean CDVA was 1.24±0.88 logMAR units.

The investigators reported that the surgical objectives were achieved in all eyes, and the mean number of surgical steps was 4.3±1.5. The mean total operative time of 1891±890 seconds with core, and shave, and total vitrectomy times were 204±120, 330±320, 534±389 seconds, respectively. The mean number of ancillary instruments used was 4.5±1.9. 

At 3 months following the operation, patients’ mean CDVA was 0.71 logMAR units, a mean improvement of 0.53±0.56 logMAR units (P <.001). The investigators reported intraoperative and postoperative AEs, including an iatrogenic retinal break in 1 eye (2%) and nicked retinal vessel in 1 eye (2%; controlled by increasing intraocular pressure [IOP]) and elevated IOP in 4 eyes (8%), hypotony in 3 eyes (6%), and re-detachment in 1 eye (2%), respectively. Most patients (82%) reported no postoperative discomfort. 

The investigators also found that the number of surgical steps was positively correlated with the total operative time (P <.05), number of ancillary instruments used (P <.05), and postoperative Day 1 IOP (P <.05) and that the number of times ancillary instrumentation was used was positively correlated with the total operative time (P <.05).

Limitations of the study included the single-center design, descriptive analysis, lack of a control group, relatively small patient population, potential variability in surgeries introduced by 3 different vitreoretinal specialists performing the operations, and potential influences of other factors, such as stage of the disease, operative complexity, patient cooperation, quality of surgical assistants, and other operating room equipment. 

The investigators report that the results of the study provide a basis for larger studies to fully examine the value of the novel beveled-tip cutter probe across a broad range of conditions.

One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.  

Reference

Uy HS, Cabahug VLO, Artiaga JCM, Chan PS, Famadico JT. Clinical outcomes of a beveled tip, ultra-high speed, 25-gauge pars plana vitrectomy system. BMC Ophthalmol. 2022;22(1):93. Published February 24, 2022. doi:10.1186/s12886-022-02311-3