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The concept of a double-action surgical cutting probe has only recently been developed and incorporated into modern vitrectomy instrumentation probes that feature 2 cutter openings in the guillotine shaft, thereby performing a vitreous cutting action on both forward and backward stroke of the probe device.
The artificial vitreous, consisting of a mixture of deionized water, agar, and hyaluronic acid sodium salt, was produced according to a protocol published by Kummer et al. Developments in vitrectomy probe technology have accelerated in recent years, designed to improve intraoperative surgical control and allow quick core vitrectomy bulk vitreous removal and tractionless controlled vitreous shaving.
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Early gauge vitrectomy systems were marked by reduced fluid flow and longer 6000 duration compared with gauge systems [ 9 ].
Both parts have an opening in the tube, allowing continuous aspiration of tissue during a complete cutter cycle movement. In vitro tests demonstrate that a more predictable and consistent flow of vitreous around the instrument probe is achieved using a TDC vitrectome compared with a regular vitrectome system. Introduction The general principle of pars plana vitrectomy PPV surgery is to ensure complete vitreous removal with no residual vitreous left following the procedure.
Trending in Retina Powered by: Aspiration flow rates remained constant independent of TDC vitrectome cut rate, while flow rates decreased linearly at higher cutter speeds using a classic single-blade vitrectome. This content is intended for health care professionals and providers only. However, enlarging the port diameter of a vitreous cutter to increase flow becomes less effective as the port becomes larger [ 2 ].
The concept of a double-cutting instrument for use in ophthalmic surgery was first patented awsociate [ 4 ]. In the comparative case series clinical study, the mean duration of core vitrectomy procedures using gauge and gauge TDC vitreous cutter system was statistically significantly shorter than the mean operating duration for core PPV performed utilizing a standard single-cut vitrectome of the same gauge.
A standard blade vitrectome of both gauges was also evaluated for aspiration flow rate at varying cut eorc when connected to an Associate machine.
Per gauge size and type at least 2 vitreous cutters were tested. Findings from this small comparative case series assessment are supportive of the efficiency of TDC vitrectome technology and of faster cut speeds for vitrectomy surgery.
This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted assoviate, distribution, and reproduction in any medium, provided the original work is properly cited.
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The average aspiration flow was calculated by averaging the measurement results of the different trials and the different vitreous cutters of the same type and gauge. Overall, vitrectomy case duration using a TDC vitrectome in combination with the EVA surgical machine was shorter than vitrectomy operating time using a standard or classic single-cut vitrectome in patients undergoing vitrectomy for epiretinal membranes. Higher cutting rates using a TDC vitrectome in combination with continuous uninterrupted aspiration flow as a result of 2 open cutting ports help to ensure faster complete vitreous removal.
Fluidic stability and control during vitrectomy is essential. This necessitates higher infusion and aspiration pressures to forc vitreous when using smaller-gauge vitrectomes.
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Evaluations reported herein are nonetheless limited by small research scale and by the fact that the same surgeon performed all vitrectomies in this single-centre clinical assessment. When the classic gauge vitrectome was connected to the Associate system, aspiration flow rate decreased from 1.
Reported findings suggest that a TDC vitrectomy probe provides greater operating efficiency than conventional vitreous cutter instrumentation during sutureless small-gauge vitrectomy. Results suggest significantly decreased operating time for core vitrectomy.
Indexed in Science Citation Index Expanded. Moreover, the continuous open port of the TDC vitreous cutter permits greater tissue removal efficiency that is unaffected by cutter velocities, showing the potential of TDC vitrectome technology for faster, less turbulent, and potentially safer smaller-gauge vitrectomy.
However, the design of new generation dual-opening vitreous cutters effectively overcomes these initial dprc by providing for consistent flow irrespective of the cut rate used during vitrectomy surgery. Retinal surgeons choose high vitreous cutter rates so as to maximize associatr stability and reduce unwanted force or traction.
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Evolution of Vitrectomy Cutter Technology. References made in article may indicate usage of medical equipment or drugs at dosages, for periods of time, and in combination not included in the current prescribing information. Size 20, 23, 25, 27 gauge. The TDC vitrectome comprises a tubular outer part and an axially movable tubular inner part arranged in the outer part [ 7 ].
The degree of retinal traction created by vitrectomy cutters is influenced by the effect of time of aspiration, distance from the retina, and cutting rate. Nearly two decades on, it was suggested that a dual port vitreous cutter system might allow surgeons to perform bulk vitrectomy more efficiently [ 5 ]. Although great care is taken to ensure that all information is accurate, it is recommended that readers seek independent verification of advice on drugs and other product usage, surgical techniques and clinical processes prior to their use.
Patients with a diagnosis at baseline of glaucoma, asteroid hyalosis, acute or chronic uveitis, or trauma were excluded. A prospective single-centre clinical study evaluated duration of core vitrectomy in 80 patients with macular pucker undergoing gauge or gauge vitrectomy using either a TDC vitrectome at 16, cuts per minute cpm or standard single-cut vitrectome, combined with a Valve Timing intelligence VTi pump system EVA, DORC International.
The second cutting movement is realized through cooperation of the distal cutting edge of the inner part with the proximal cutting edge of the outer part. The same tests were then performed using artificial vitreous humor as aspirating fluid.
Assoicate of advertising materials on the website thereof, does not constitute and representation or guarantee by Beye LLC of the quality of such products, or of the claims made. Table 2 tabulates the mean duration of core vitrectomy associaye for each surgical intervention group assessed. Advocates of microincisional vitrectomy instrumentation highlight surgical advantages compared with conventional gauge surgery in addition to sutureless vitrectomy capability, namely, reduced operating time, greater precision in performing delicate maneuvers, less tissue manipulation, and reduced postoperative inflammation and rapid visual recovery [ 1112 ].
Investigators found that, using modified gauge vitrectomy probes, the time of aspiration remained almost constant irrespective of cutting speed, indicating almost no reduction of flow but, more importantly, that aspiration time was significantly reduced compared with a standard single port cutter.
Megatron Cool Geuder AG. Beye LLC, via its Editors and Publisher, accepts no responsibility for any injury or damage to persons or property occasioned through the implementation of any ideas or use of any product described herein. Before each test, a priming procedure was performed to ensure that the aspiration tubing of the cutter was completely filled with water and that the cutter was positioned with its tip into a cup filled with fluid.
Time and flow data were analyzed using linear least squares regression analyses and two-tailed -tests. The study adhered to the tenets of the Declaration of Helsinki, and local regulatory requirements were fulfilled.
Retinal traction increases with increasing aspiration vacuum and proximity to the retina and decreases with higher cut rates [ 1 ]. Inclusion criteria were chosen to ensure adherence to a similarity principle, with similar vitreous liquefaction, similar case duration and difficulty, similar vitreous volume, and similar overall ocular conditions having had no prior ocular surgical intervention.