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



Surgery Treatments

What is 25 Gauge Vitrectomy?

25 gauge vitrectomy is safer due to smaller openings and thinner intrument shafts.Vitrectomy is an eye operation usually performed by a retinal specialist to treat a variety of retinal conditions.  Most vitrectomies are performed to treat:

1.  Retinal Detachments
2.  Epiretinal Membranes
3.  Macular Holes
4.  Floaters
5.  Blood, aka Vitreous Hemorrhage

25 Gauge Vitrectomy is as Safe as Cataract Surgery

For me, this is state of the art.  A 25 gauge vitrectomy uses thinner instruments compared to the older 20 gauge vitrectomy system (the higher the number, the thinner the instruments).  I have rarely used a 20 gauge system in the last 5-7 years.  There really is no need.

To most, the largest advantage of the thinner system is the small incisions, or holes, needed to enter the eye.  The entry areas are so small, stitches are not needed as they self-seal.  This shortens the operation as I don’t have to spend time stitching the entry wounds in the sclera and conjunctiva.

While shortening operating time is great, the biggest advantage is quicker healing and comfort to the patient!

25 Gauge Vitrectomy Causes Fewer Retinal Tears

Compared to older technology, or 20 gauge vitrectomy systems, 25 gauge systems are also safer for the patient.  While infection rates have been traditionally lower in retinal operations, the smaller gauge vitrectomy systems now cause far fewer retinal tears compared to the 20 gauge, larger, predecessor.

Hence, 25 gauge vitrectomy is now as safe or safer than cataract surgery.

Coffee Stirrer vs. Straw

In addition to faster operating and quicker healing, the smaller and thinner instruments cause fewer tears due to the fact that thinner instruments can not generate as much “sucking” force as wider/fatter instruments.

Try drinking through a coffee stirrer versus and drinking straw.  That’s the difference between 25 gauge (thinner) and 20 gauge (thicker) instrumentation.

As a result, the newer instruments can not pull on the vitreous as forcefully as the thicker instrument.

The vitreous is very adherent to the retina in certain parts of the eye.  Pulling on the vitreous can, therefore, cause a retinal tear.

What Does this Mean?

Modern vitrectomy is very safe.  Fewer complications occur with the 25 gauge system.  The chance of blinding infection (endophthalmitis) has always been lower in vitrectomy compared to cataract surgery.  Now, with advanced technology, the thinner vitrectomy system causes far fewer retinal tears (and, therefore, retinal detachments).

While the thinner instruments do have intuitive advantages for doctor and patient such as quicker healing, fewer office visits and speedier operating time.

The fact that fewer tears are created escapes most physicians (even some retina specialists).  The changes in size, smaller openings and thinner instrumentation, has allowed vitrectomy eye surgery to become a very safe surgery.



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




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