Skip to main content
SpringerLink
Log in

Performance analysis of new-generation vitreous cutters

  • Basic Science
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Background

Despite their clinical advantages, smaller-diameter vitrectomy systems pose significant challenges in vitreous removal. The percentage of time the vitreous cutter port is open while cutting (duty cycle) is one of the primary factors that affect flow. Herein, we examine the effect of duty cycle on the flow performance of new-generation cutters relative to current instrumentation.

Methods

Performance of 25-gauge (ga) and 20-ga new-generation spring-return pneumatic cutters (n = 24 and n = 28 respectively) was analyzed relative to current-generation cutters, across their specified cut-speed range under clinical vacuum pressures of 500 mmHg (25-ga) and 200 mmHg (20-ga). A precision balance measured mass of water or porcine vitreous removed from a vial by a cutter; this was recorded in real-time and converted to flow rates. Frame-by-frame analysis of high-speed video was used to determine duty cycle. Data was analyzed using linear regression and the t-test.

Results

Compared with the current-generation, the new-generation cutters exhibit increasingly greater water flow rates at higher cut speeds (P < 0.001). Vitreous flow rates of the new-generation cutters are relatively constant as cut speed increases, and are significantly greater than those of the current-generation cutters at cut speeds of 1500 cuts per minute (CPM) or higher (P < 0.001). The new-generation 25-ga cutter exhibits greater vitreous flow rates at higher cut speeds than the current-generation 20-ga cutter: at 2000 and 2500 CPM, the new 25-ga cutter has 1.45 and 11.88 times the vitreous flow rate of the current 20-ga cutter (P < 0.001) respectively. Duty cycles of the new-generation cutters are significantly higher than those of the current-generation at all cut speeds (P < 0.001).

Conclusions

Although a number of factors influence flow, the high and relatively constant vitreous flow rates of the new-generation cutters are most likely due to their maintenance of high duty cycle as cut speed increases. The findings illustrate that in optimizing duty cycle, the vitreous flow efficiency of smaller-diameter cutters can match or exceed that of larger diameter cutters.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. The Preferences and Trends Survey 2006. American Society of Retina Specialists website: http://www.asrs.org/.

  2. Magalhaes et al. American Society of Retina Specialists-European VitreoRetinal Society Annual Meeting, Cannes, France, September 2006.

  3. Magalhaes et al. American Society of Retina Specialists-European VitreoRetinal Society Annual Meeting, Cannes, France, September 2006.

  4. Magalhaes et al. American Society of Retina Specialists-European VitreoRetinal Society Annual Meeting, Cannes, France, September 2006.

  5. Magalhaes et al. American Society of Retina Specialists-European VitreoRetinal Society Annual Meeting, Cannes, France, September 2006.

  6. Magalhaes et al. American Society of Retina Specialists-European VitreoRetinal Society Annual Meeting, Cannes, France, September 2006.

  7. DeBoer et al. 2006 Association for Research in Vision and Ophthalmology abstract #5254.

  8. Magalhaes et al. American Society of Retina Specialists-European VitreoRetinal Society Annual Meeting, Cannes, France, September 2006.

  9. It is important to note that at 2500 CPM, the current-generation 20-ga pneumatic cutter experiences incomplete port opening which may also affect flow rate.

References

  1. Fujii GY, de Juan E, Humayun MS, Pieramici DJ, Chang TS, Awh C, Ng E, Barnes A, Wu SL, Sommerville DN (2002) A new 25-gauge instrument system for transconjunctival sutureless vitrectomy surgery. Ophthalmology 109:1807–1812

    Article  PubMed  Google Scholar 

  2. Fujii GY, de Juan E, Humayun MS, Chang TS, Pieramici DJ, Barnes A, Kent D (2002) Initial experience using the transconjunctival sutureless vitrectomy system for vitreoretinal surgery. Ophthalmology 109:1814–1820

    Article  PubMed  Google Scholar 

  3. Lahey JM, Francis RR, Kearney JJ (2003) Combining phacoemulsification with pars plana vitrectomy in patients with proliferative diabetic retinopathy: a series of 223 cases. Ophthalmology 110:1335–1339

    Article  PubMed  Google Scholar 

  4. Lakhanpal RR, Humayun MS, de Juan E, Lim JI, Chong LP, Chang TS, Javaheri M, Fujii GY, Barnes AC, Alexandrou TJ (2005) Outcomes of 140 consecutive cases of 25-gauge transconjunctival surgery for posterior segment disease. Ophthalmology 112:817–824

    Article  PubMed  Google Scholar 

  5. Ibarra MS, Hermel M, Prenner JL, Hassan TS (2005) Longer-term outcomes of transconjunctival sutureless 25-gauge vitrectomy. Am J Ophthalmol 139:831–836

    Article  PubMed  Google Scholar 

  6. Yanyali A, Celik E, Horozoglu F, Oner S, Nohutcu AF (2006) 25-Gauge transconjunctival sutureless pars plana vitrectomy. Eur J Ophthalmol 16:141–147

    PubMed  CAS  Google Scholar 

  7. Kellner L, Wimpissinger B, Stolba U, Brannath W, Binder S (2007) 25 Gauge versus 20 Gauge System for Pars Plana Vitrectomy: A Prospective Randomized Clinical Trial. Br J Ophthalmol doi: 10.1136/bjo.2006.106799

  8. Chen E (2007) 25-Gauge transconjunctival sutureless vitrectomy. Curr Opin Ophthalmol 18:188–193

    Article  PubMed  Google Scholar 

  9. Hubschman JP (2005) Comparison of different vitrectomy systems (French). J Fr Ophthalmol 28:606–609

    Article  Google Scholar 

  10. Oshima Y, Ohji M, Tano Y (2006) Surgical outcomes of 25-gauge transconjunctival vitrectomy combined with cataract surgery for vitreoretinal diseases. Ann Acad Med Singapore 35:175–180

    PubMed  Google Scholar 

  11. Machemer R, Buettner H, Norton EW, Parel JM (1971) Vitrectomy: a pars plana approach. Trans Am Acad Ophthalmol Otolaryngol 75:813–820

    PubMed  CAS  Google Scholar 

  12. Bronner A, Nemeth-Wasmer G (1972) Vitreous body (French). Arch Ophtalmol Rev Gen Ophtalmol 32:593–602

    PubMed  CAS  Google Scholar 

Download references

Acknowledgements

This work was supported in part by Research to Prevent Blindness and the National Eye Institute (NIH/NEI grant EY03040).

The authors would like to thank Gerald Chader, Ph.D. for serving as scientific advisor; Lawrence P. Chong, M.D. for serving as clinical advisor; Prashant R. Bhadri, PhD for assistance in statistical analysis of the data; Octaviano Magalhaes Jr., MD, MBA for allowing us to reference his work; Joel M. Cicchella, BS for assistance in data collection; and Ralph M. Kerns, BS for assistance in design of the study.

Author information

Authors and Affiliations

  1. Eye Concepts, Doheny Eye Institute, 1450 San Pablo Street, DVRC 119, Los Angeles, CA, 90033-3699, USA

    Sophia Y. Fang, Charles M. T. DeBoer & Mark S. Humayun

  2. Departments of Ophthalmology & Biomedical Engineering, University of Southern California, Los Angeles, CA, USA

    Mark S. Humayun

Authors
  1. Sophia Y. Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Charles M. T. DeBoer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark S. Humayun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark S. Humayun.

Additional information

All authors are members of the Eye Concepts laboratory at the Doheny Eye Institute. Eye Concepts receives research funds which are part of an advanced royalty distribution agreement between Bausch & Lomb, Inc. and the Doheny Eye Institute. No financial relationship exists between MID Labs (the manufacturer of the AVE vitreous cutters discussed in this manuscript) and Eye Concepts or the Doheny Eye Institute. Bausch & Lomb, Inc. has nonexclusive distribution rights for the AVE cutters manufactured by MID Labs.

The authors have full control of all primary data, and agree to allow Graefe’s Archive for Clinical and Experimental Ophthalmology to review the data upon request.

Appendix

Appendix

The ‘new-generation 25-ga and 20-ga spring-return pneumatic vitreous cutters’ refer to the Adaptable Vit Enhancer (AVE) cutters (MID Labs, San Leandro, CA, USA). The AVE cutters were operated with an AVE 2500p Console (MID Labs) connected to a host Millennium Microsurgical System (Bausch & Lomb, St. Louis, MO, USA). The ‘current-generation 20-ga and 25-ga spring-return pneumatic cutters’ refer to the Accurus 2500 and the Accurus cutters (Alcon, Fort Worth, TX, USA) respectively.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fang, S.Y., DeBoer, C.M.T. & Humayun, M.S. Performance analysis of new-generation vitreous cutters. Graefes Arch Clin Exp Ophthalmol 246, 61–67 (2008). https://doi.org/10.1007/s00417-007-0672-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00417-007-0672-8

Keywords

Search

Navigation