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
- 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