Matthew Mccormick

An experimental protocol of the model to quantify traction applied to the retina by vitreous cutters.

PURPOSE The purpose of this study was to use a novel method to quantify the traction applied to the retina during vitrectomy. METHODS Five 20-gauge electric cutters were used. Fresh porcine eyes were positioned in a specially developed holder and transfixed to the retinal layers with a microwire, and the other end was fixed to the load cell of a strain gauge. The cutter to be assessed was introduced into the eye by a micromanipulator at a 45 degrees angle adjacent to the retina. The traction force was evaluated when the cutter was at 3 and 5 mm from the retina. As control, the experiment was repeated in eyes filled with water, and the results were compared to those when the eyes had vitreous gel. RESULTS Results from the eyes with vitreous gel indicate that retinal traction increased with increasing aspiration vacuum (7.90 dyn for each 100 mm Hg increased; P < 0.05) and proximity to the retina (2.17 dyn; P < 0.05) and decreased with increasing cut rate (2.51 dyn for each 500 cuts per minute increased; P < 0.05). In all eyes filled with water, traction was not observed. CONCLUSIONS The present study establishes a new reproducible technique to quantify vitreoretinal traction during vitrectomy and demonstrates that the effects of aspiration, distance from the retina, and cut rate are crucial factors in the amount of retinal traction created by vitreous cutters.

Novel method to quantify traction in a vitrectomy procedure

Aim To report a novel method to quantify traction applied to the retina using vitreous cutters during pars plana vitrectomy. Methods Fresh porcine eyes were positioned in a specially developed holder and transfixed to the retinal layers with a wire and the other end fixed to the load cell of a strain gauge. Five separate 20-gauge electrical drive mechanism vitrectors were introduced into the eye at a 45° angle and positioned at a distance of either 3 or 5 mm from the retina. Data from the strain gauge were acquired and the traction force computed. Results The analysis revealed that the vitreoretinal traction increased by 7.90 dynes for each 100 mm Hg increase in vacuum (p<0.05). The traction forces decreased by 2.51 dynes for each 500 cuts per minute increased (p<0.05) and the traction force increased by 2.17 dynes at 3 mm compared with 5 mm (p<0.05). Conclusion The traction was directly proportional to the aspiration vacuum and inversely proportional to the cut rate. The cutter traction force increased with proximity to the retina.

A new dual port cutter system for vitrectomy surgery.

Purpose: To evaluate and compare the performance of several designs of 20-gauge dual port (DP) vitreous cutter tips with a standard 20-gauge single port tip. Methods: Custom 20-gauge pneumatic vitreous DP cutter tips with different sizes and port positions were evaluated through porcine vitreous and water flow rates. Five designed and fabricated DP cutter tips were compared with a normal single port control tip and evaluated by the measurement of water and porcine vitreous flow rates, and surgical examination in enucleated porcine eyes. Results: Some DP tips approached a maximum vitreous and water flow rates, removing water and vitreous faster than the normal control tip. With reference to surgical evaluation, some DP tips performed better than the single port tip for bulk vitrectomy, but none shaved the vitreous base more effectively. Conclusion: The DP cutter system has the potential to increase the flow rates depending on the size and position of the extra port. In the future, the DP cutter may allow the surgeon to perform bulk vitrectomy more efficiently.