The integration of combined cataract and vitrectomy surgery into modern ophthalmic surgery systems has remarkable benefits for many patients, especially those with simultaneous anterior and posterior segment pathologies.
These all-in-one surgical platforms are providing surgeons with ultimate control – which is of paramount importance to every surgical procedure. And features, like hypersonic technology, are proving to be a game changer in vitrectomy.
The Vitesse hypersonic vitrectomy system, exclusive to Stellaris Elite (Bausch+Lomb, Rochester, NY, USA), represents a revolutionary approach to vitreous removal. Using hypersonic technology, it liquefies vitreous for a new level of surgical control and precision. As opposed to standard cutters, hypersonic technology creates first a vitreous liquefaction highly-localized at the front of the port, then liquefied vitreous is aspirated. Its open-port design is 100 percent open 100 percent of the time for consistent flow, and its unique single-lumen design provides unobstructed aspiration.
“The Stellaris Elite is an excellent platform for vitrectomy and I find its integrated Vitesse hypersonic vitrectomy capability quite compelling,” said Dr. Carl C. Awh, the president of Tennessee Retina in Nashville, Tennessee, USA. Dr. Awh, who has used the Stellaris since it became commercially available, noted that the bi-blade vitrectomy cutter is outstanding and compared to other 27-G probes he has used, the Stellaris Elite bi-blade 27-G cutter is superior. “It has a higher flow rate and more effectively removes vitreous,” he shared.
“The Stellaris Elite has enabled us to function very efficiently and effectively in a very busy vitreoretinal practice, and we can address all of the surgical challenges that retinal surgeons are familiar with. We don’t do cataract surgery in our practice but if we did, that would be a major advantage with the Stellaris Elite platform because it’s an outstanding phacoemulsification unit as well,” added Dr. Awh.
In his clinical practice, Dr. Awh has performed numerous retinal surgical procedures utilizing the Stellaris Elite and highlighted a recent case in which the Stellaris Elite proved particularly beneficial. “This was a very challenging case. The patient had total retinal detachment and a dislocated crystalline lens. Using the Stellaris Elite’s bi-blade cutter, I was able to completely remove all the dislocated lens material and then repaired the retinal detachment,” he shared.
Furthermore, Oertli Instrumente AG (Berneck, Switzerland) has developed the next generation of surgical platforms. One of them is the OS 4, with the primary aim of increasing the direct control of the surgeon’s actions and decreasing surgery time. The OS 4 is a powerfully efficient all-in-one platform for cataract, glaucoma and vitreoretinal surgery. As a versatile and user-specific OR device, the OS 4 works as the extended hand of the surgeon and carries out his orders and intuitions perfectly.
Talking about his reason for adopting the Oertli OS 4 platform in his practice, Dr. Manzar Saeed, MBBS, FRCSEd, FRCOphth, consultant ophthalmic surgeon at the Queen Elizabeth Hospital NHS Foundation Trust, King’s Lynn Norfolk, UK, stated that having tried other machines, OS 4 turned out to be the most feasible choice. “It has out-performed competitors in technical performance. The business model was suited to my hospital’s financial preferences as well. It’s simplicity of design and engagement with the manufacturing design team instilled extra confidence in me as a surgeon,” explained Dr. Saeed.
At first encounter, highlighted Dr. Saeed, the ease of use of the OS 4 platform was just remarkable. “My first-hand experience with the OS 4 led me to believe that it is not merely an upgrade from OS 3 (previous machine generation from Oertli) but an altogether new machine. OS 4 set-up and troubleshooting (never required so far), is also easy to learn from a nurse assistant’s point of view,” he shared.
Dr. Saeed also highlighted some outstanding features of the OS 4 platform. “Its 23-gauge gives me the best of both worlds: uncompromised speed, sutureless ports, viscous fluid injection as well as extraction without the need to enlarge ports. Also, OS 4 sclerotomy ports are stable and do not have leakage problems. Its pedal can be customized to have total and constant control over vacuum and cut rate,” he explained.
The platform’s versatility across a range of indications is truly remarkable, noted Dr. Saeed. “With the all-in-one OS 4 platform I can perform whole range of cases from simple to highly complex, as well as from soft to very hard cataracts. In complex cases such as diabetic vitrectomy whereby vitreous base shaving is common, control is of paramount importance,” said Dr. Saeed.
Dr. Saeed recalled a clinical case in which the performance of the Oertli all-in-one OS 4 platform was exceptional. “I had this trauma case where the lens had dislocated from the vitreous. This was complicated by dense vitreous hemorrhage. During vitrectomy, a retinal detachment with over 180-degree giant retinal tear was encountered. The OS 4 high performance bi-directional Continuous Flow Cutter performed extremely well in removing the hard lens nucleus safely and efficiently,” he shared.
“Also, I was able to tailor the vitrectomy with different pumps [thanks to Peristaltic, SPEEPMode and Venturi options]. My default option is usually the unique SPEEPMode,” added Dr. Saeed.
In this case, the lens nucleus was removed with a Venturi pump while maintaining maximum suction and minimizing retinal damage by the free-floating lens fragments. Peristaltic pump was employed during vitrectomy of anterior vitreous and base shaving, coupled with ultra-high speed 10,000 cut rate, allowing smooth operation without causing iatrogenic tears on a mobile retina.
“The dual linear foot pedal is a great design which I have customized to allow independent control of vacuum and cut rate – parameters which I can constantly change during vitrectomy,” he further explained.
And then there’s the simplicity of the Oertli OS 4 as a teaching tool: “The OS 4 is great for teaching due to its customizable foot pedal. I have found it incredibly useful to teach trainee surgeons, both for cataract and pars plana vitrectomy. I would recommend the Oertli all-in-one OS 4 platform unreservedly to other retinal surgeons,” concluded Dr. Saeed.
