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However, enlarging the port diameter of a vitreous cutter to increase flow becomes less effective as the port becomes larger [ 2 ]. In vitro evaluations were undertaken to assess volumetric aspiration flow rates the main outcome measure of a two-dimensional cutting vitrectome compared with a standard vitrectome of the same gauge. 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.
A TDC vitrectome delivered good overall stability in aspiration flow rate that is independent of cut speed. 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.
Statistical significance value of comparison between PPV durations performed using standard and TDC vitreous cutters was set at 0. 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.
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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. The axial position of the distal cutting edge of the inner part as a function of the circumferential direction initially proceeds towards the proximal end and then back to the distal end again.
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.
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. The outer part has a closed distal end and the inner part an open distal end.
Evolution of Vitrectomy Cutter Technology. To receive news and publication updates for Journal of Ophthalmology, enter your email address in the box below. Contact Us About Beye. During a cycle in which the dor part performs a back-and-forth movement in the outer part, a cutting movement occurs 66000. The principal advantages of this novel guillotine sleeve design included a doubling of cut rate, increased flow, and potentially decreased retinal traction or force exerted by the probe.
Results suggest significantly decreased operating corc for core vitrectomy. Initially, these tests were performed with water. Time measurement of core vitrectomy duration was made by a secondary person without a need to change standard vitrectomy procedures of PPV for epiretinal membrane removal. 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 ].
Mean duration of core vitrectomy operating time for gauge and gauge surgeries utilizing either a standard single-cut or dkrc TDC vitrectome.
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Figure 1 illustrates core design elements of a TDC vitrectome and a classic single-cut vitrectome. A principal goal in PPV is to minimize vitreous traction by removing only the target ocular tissue, without inadvertently drawing unwanted tissue into the vitrectomy probe port or creating distant traction that might cause iatrogenic retinal tears or other complications.
The concept of a double-cutting instrument for use in ophthalmic surgery was first patented in [ 4 ]. Size 20, 23, 25, 27 gauge. Fluidic stability and control during vitrectomy 60000 essential. Indexed in Science Citation Index Expanded. This is an open access article distributed under the Creative Commons Attribution Licensewhich permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Owing to the associatte cutting and snipping capacity, the surgical intervention can be shortened and, moreover, the traction exerted on the ocular tissue drawn in during the aspiration phase decreases while the suction flow increases.
A first cutting movement occurs by cooperation of the distal end of the inner part with the distal cutting edge of the outer part. 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.
Associate Dual allows for flow controlled vitrectomy and vacuum controlled high speed vitrectomy. Inclusion 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.
Megatron Cool Geuder AG. The TDC vitrectome comprises a tubular outer part and an axially movable tubular inner part arranged in the outer part [ 7 ].
We evaluated overall vitrectomy cutting time in seconds required to remove core vitreous in 80 patients diagnosed with macular pucker as part of a comparative evaluation of flow and operating duration using a TDC vitrectome and former standard single-cut vitrectome design gauge and gauge systems, DORC during core vitrectomy procedures.
Reported findings suggest that a TDC vitrectomy probe provides greater operating efficiency than conventional vitreous cutter instrumentation during sutureless small-gauge vitrectomy. Faster operating times offer the potential of reduced costs as well quicker postoperative rehabilitation [ 14 ].
Nearly two decades on, it was suggested that a dual port vitreous cutter system might allow surgeons to perform bulk vitrectomy more efficiently [ 5 ]. Table of Contents Alerts. Introduction The general principle of pars plana vitrectomy PPV surgery is to ensure complete vitreous removal with no residual vitreous left following the procedure.
After activation of the vitreous cutter, a small time was allowed for attainment of a constant vacuum level in the aspiration tubing.
Per gauge size and type at least 2 vitreous cutters were tested. 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. For all associiate performed, a density of 1. The same tests were then performed using artificial vitreous humor as aspirating fluid.
Both parts have an opening in the tube, allowing continuous aspiration of tissue during dorv complete cutter cycle movement. 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.
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In vitro investigations compared aspiration flow rates in artificial vitreous humor at varying cutter speeds and vacuum levels using a TDC vitrectome and a standard vitrectome across different aspiration pump systems.
Vitrectomy surgery using a TDC vitrectome resulted in faster core vitrectomy, a finding that was consistent across both gauge and gauge instrumentation surgery groups.
A prospective single-centre clinical study evaluated duration of core vitrectomy in awsociate 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 eorc a Valve Timing intelligence VTi pump system EVA, DORC International.