Alcon Constellation System Provides the Safest Vitrectomy

Alcon Constellation System Provides the Safest Vitrectomy





The best vitrectomy eye surgical system is the Constellation Vision System from Alcon.

25 gauge vitrectomy is safe, but the Alcon Constellation 25 gauge vitrectomy is the safest.

25 Gauge Vitrectomy is Safest

The older 20 (but not obsolete) gauge system uses thicker and larger instruments.  25 gauge systems have inherent safety advantages due to their smaller and thinner sized instruments.

25 gauge systems (sutures are not required to close the entry points into the eye) were marketed to be easier and faster for the surgeon to use as well as faster healing time for the patient due to the lack sutures. It is also much more comfortable for the patient.

Smaller instruments also are safer, yet most eye doctors (including many retina specialists) are not aware of the inherent advantages to these smaller and thinner instruments.

Essentially, smaller and thinner makes it less likely to cause a retinal tear.

Retinal tears can lead to retinal detachments.  One of the dreaded complications of vitrectomy.

Constellation by Alcon is State of the Art

There are numerous advantages to the Constellation Vision System, but the two listed are the most relevant to you:

Cut speeds:  The Constellation Vitrectomy System allows cut speeds of up to 7500/minute.  This higher cut speed results in a faster and safer vitrectomy as there is almost no traction (pulling) placed on the peripheral vitreous, thus, less chance of creating a retinal tear during the eye operation.  This is the biggest advantage over other systems, such as the Accurus (the predecessor to the Constellation Vision System and also made by Alcon).

Customized Cutting:  Without going to detail, the Alcon Constellation 25 gauge vitrectomy can be customized in the way the tool actually opens and closes to cut the vitreous.  This enhanced control allows the surgeon (me) to avoid inadvertent cuts on the retina….another huge safety feature.

Advantages for the Surgeon (me)

Other advantages are listed below and are really esoteric for you (most of my readers), however, the increased surgeon control allows for fewer people required during the operation, thus, improving safety, speed and efficiency.

Controlled Intraocular Pressure:  The Constellation has a controlled fluidic management system.  This allows the surgeon to better control the intraocular pressure compared to older “gravity” based systems.  In addition, valved cannulas (these are little sheaths which pierce the sclera [shell of the eye] and allow safe introduction of instruments into the eye) keep intraocular pressure more predictable during the operation.

Increased Surgeon Control:  Essentially the Constellation Vision System allows the surgeon to perform and initiate many more surgical procedures without the need of an assistant, such as;

  • Fluid Air Exchange
  • Diathermy
  • Proportional Reflux
  • Laser Control

What Does This Mean?

The Constellation Vision System is simply the best and safest system available.  The Accurus system, a predecessor of Constellation, made by Alcon, revolutionized vitrectomy eye surgery by introducing 25 gauge vitrectomy.  The safety of the 25 gauge vitrectomy is optimized by the Constellation Vision System and so is patient comfort.

Faster operating times, better surgical control, fewer humans and state-of-the-art technology equate to the safest vitrectomy surgery possible.  Fewer variables and fewer possible complications such that vitrectomy surgery is as safe, or safer, than modern cataract surgery.

Due to the improvements in safety, the spectrum of diseases available to surgical cures increases.  Removal of epiretinal membranes, closure of macular holes and removal of floaters are now more viable options compared to 5-10 years ago when we didn’t have safer alternatives.

And the future is even smaller.  Soon I will be offering 27g vitrectomy surgery…


Randall V. Wong, M.D.
Ophthalmologist, Retina Specialist
Fairfax Virginia



  • Eric
    Posted at 21:06h, 14 July Reply

    Hi Dr. Wong,

    Great article, thanks for sharing! The part at the end about 27g vitrectomy caught my eye – when do you think you will start using those tools – any rough timeline? If I recall correctly, you had mentioned in the past about being heisitant to use them because they weren’t quite as sturdy as the 25g instrumentation.

    What advantages do you think 27g will offer over 25g?

    Thanks for all that you do!


  • Ken
    Posted at 21:23h, 14 July Reply

    It would be nice if some improvements were made with respect to optics. I don’t think the current instruments allow the surgeon to see enough of the area towards the anterior portion as well as the ciliary body portion where the ports enter during the surgery. I know that vitrectomies are performed for a variety of reasons but for those of us who have had or are looking to have vitrectomies for opacities (floaters), I think that inadequate optics are responsible for the less than fully satisfied results being realized by patients. Residual floaters and vitreous “frill” seem to be a consistent complaint among patients who have underwent vitrectomy surgery for floaters. It doesn’t really matter if the patient has had a natural PVD, had PVD induced as part of the surgery, or has had a “core” vitrectomy. The consistent theme on message boards is that while the surgery is very successful in removing the most bothersome floaters, however residual floaters and vitreous frill seem to be the trade-off. Some may say you are trading one annoyance for another. Add to that, the risks of the surgery and a likelihood of cataract development in older patients and the decision to pursue a vitrectomy becomes somewhat confusing. I have had vitrectomies for floaters in both eyes and am very happy so I am a strong advocate of the surgery as well as the surgeons, like yourself, who perform them. The surgery is very necessary and in my case, gave me my life back.

    You are the pioneer in this arena and clearly a favorite among floater sufferers, both past and current, including myself. I guess I look to you to help develop what I perceive as a necessay improvement to the surgery. I agree with instrumentation improvements with respect to safety but thoroughness needs to be addressed if surgeons are going to perform vitrectomies for opacities.

    I always look forward to reading you articles and watching your videos. I’m a huge fan of yours and feel that you are the hope standing between floater sufferers and normal life. Thanks Randy

    • Randall V. Wong, M.D.
      Posted at 19:12h, 27 July Reply


      Thanks for all the support.

      Over the past 6 months, I’ve heard that my “popularity” online has increased.

      I’m not so sure your concerns regarding residual floaters and “frill” are actually a problem of optics.

      1. I think there are two general groups of floater sufferers

      a. Older with visible opacities (to the examiner/doctor)
      b. Younger with fewer or no visible opacities

      2. I think there is something different with the younger vitreous. e.g. refractive index of the vitreous

      3. Frill seems to be overtaking concern for cataract formation, that is, I may consider complete removal of the vitreous.

      Thanks for the support!

      Did you read my “rebuttal” on frill?

      Randall V. Wong, M.D.
      Retina Specialist
      Fairfax, Virginia 22031

  • Laurence Parker
    Posted at 20:43h, 15 July Reply

    Hello Dr. Wong,
    I’ve contacted you previously and have followed your posts. Thank you for all the great information. I’ve seen several doctors including the one who performed my lasik surgery about 7 years ago. All have made a concerted effort to put the fear in me when it comes to vitrectomy. My right eye is the worst, with basically a smudge in my field of vision it all but drives me crazy at times. I’m am 51 and I don’t see (no pun intended) myself dealing with this for much longer. I know that each case can be different but, would mind speaking to what “generally” is the cost of this procedure and will my insurance company pick up any of the cost? I know I will have to check with Aetna but, I thought you could speak from experiences so far.
    Thank you so much for the updates on this procedure.


  • Paul
    Posted at 11:40h, 16 August Reply

    Maybe a curved 25 gauge vitrector is the answer,I woyld immagine you could reach more areas of the eye.

  • Jack
    Posted at 16:39h, 27 August Reply

    Dr. Wong,

    What benefits do you see going to the 27g system? I am on the fence about FOVs to remove two large floaters in both eyes, and am always interested in reading about new developments. Thanks.

    • Randall V. Wong, M.D.
      Posted at 21:21h, 28 August Reply


      In my opinion, with the smaller incisions (27 gauge vs. 25 gauge), there may be a decreased incidence of immediate hypotony after the operation. While this occurs, it does not cause any long term sequelae, so it may only be a short advantage. There may be even less tendency for the retina to tear, but the chance is already so low with 25 gauge.


  • Pingback:What is the Difference between FOV and Vitrectomy
    Posted at 00:02h, 02 January Reply

    […] As of this writing (December 2013), I prefer operating using a 25 gauge vitrectomy system made by Alcon.  25 gauge systems are much safer than the older 20 gauge systems, but the Constellation Vision System is the best. […]

  • Mike
    Posted at 12:01h, 02 January Reply

    Dr. Wong,

    Thank you again for all the information that you provide to all of us.

    I’ve written to you before thanking you for “pushing” me in the right direction and having a much needed vitrectomy performed by another retina specialist. I already had a retina specialist and had the surgery scheduled but was going to cancel it when I ran across your blog and all the information that you provided finally convinced me that I was doing the right thing. That procedure turned my life around.

    However; I suffer from a Weiss ring in the center of my vision in the other eye and I’m going to contact your office and have you perform the vitrectomy on that eye. In the past six months I’ve developed dry eye syndrome in the eye that has the Weiss ring. Will that compromise the surgery due to the fact that I will need to use all of the prescription drops after surgery and with my eye watering all the time do you think I might be susceptible to infection because the medication would be just washed out?

    Thank you.

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