Abstract
PurposePreliminary assessment of a new prototype ultrasound-based hypersonic vitrector (HV) by qualitatively examining the histopathological changes in the retina and vitreous body after pars plana vitrectomy (PPV) and its ability to fragment vitreous collagen.MethodsFourteen porcine cadaveric eyes, 20 eyes in live swine and six human cadaveric eyes underwent PPV using the HV or a pneumatic guillotine vitrector (GV). An additional 4 porcine crystalline lenses were touched with either the HV or GV for 1 minute. Following PPV, human vitreous was removed and processed for electron microscopy (EM). Eyes and lenses were fixed and sectioned for light microscopy (LM).ResultsThere were no macroscopic retinal or optic nerve defects associated with either HV or GV PPVs. Cadaveric retinal specimens showed separation of the inner limiting membrane (ILM) and vacuolization and fragmentation at the nerve fiber layer (NFL) and the ganglion cell layer (GCL). ILM fragmentation and separation were found after PPV in live swine with both vitrectors. Small disruptions of the posterior capsule or structural lens defects were found after HV touch. The EM analysis revealed more fragmentation of human vitreous collagen fibrils after HV compared to GV PPV.ConclusionsLM and EM analysis of retina, vitreous, and crystalline lens after PPV showed similar morphological changes using the HV or the GV. Vitreous fragmentation appeared more effective with the HV. Overall this study suggests that the HV may be a promising new technology. More work is needed to quantitatively assess its safety and efficacy.
Highlights
The goal of all vitreous surgery is to minimize collateral damage while maximizing efficiency [1]
inner limiting membrane (ILM) fragmentation and separation were found after pars plana vitrectomy (PPV) in live swine with both vitrectors
The electron microscopy (EM) analysis revealed more fragmentation of human vitreous collagen fibrils after hypersonic vitrector (HV) compared to guillotine vitrectors (GV) PPV
Summary
The goal of all vitreous surgery is to minimize collateral damage while maximizing efficiency [1]. A concomitant disadvantage is a decrease in flow rate and sometimes greater vitreous traction with smaller gauge vitreous cutters [1]. There may be an upper limit to the achievable speed of the vitreous cutter blade [6]. A promising alternative to GV is the application of ultrasound (US) to liquefy and excise the vitreous [6,7,8]. US technology is widely accepted for vitrectomy during complicated cataract surgery to remove lens fragments from the posterior cavity with an US fragmentation handpiece [9,10,11,12]. Low power US harmonics may provide an alternative to GVs
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