3 minute read
New vitreoretinal surgery techs benefit both surgeon and patient
New Technology Benefits Both Patient and Surgeon
by Brooke Herron
The continued innovation of ophthalmic instrumentation and devices has revolutionized vitreoretinal surgery — today, surgeons are able to view the posterior segment more clearly than ever before and new tools can provide added efficiency and safety. Therefore, on the last day of the American Society of Retina Specialists 38th Annual Scientific Meeting (ASRS 2020), experts convened to discuss the latest advances during the Instrumentation and Devices Symposium.
Latency: No bother
The first paper assessed was The Effect of Latency on Digital Retinal Surgery by David Tri Ta Kim, MD, and Daniel Chao, MD. The authors found no significant difference in performance associated with different digital latency levels (50, 66, 90 and 122 milliseconds) and concluded that differences in latency have no negative impact.
So, did prior experience with digital systems influence these results in subjective usability? The answer is yes. People that had used digital microscopes before were less likely to be bothered by even higher levels of latency, according to Dr. Kim.
Keep your cool
Next, Dr. Chao discussed his results on Cooling Anesthesia for Intravitreal Injection with a Novel Device: Results from the Prospective COOL-2 Study.
As to the benefit of cooling anesthesia, Dr. Chao said: “All of the four types of anesthetics would effectively and safely perform the injection, but we think that it’s the patient and physician experience that may really benefit.
“We don’t think that cooling anesthesia is providing superior pain control at the time of injection, but because of the rapid onset of the anesthesia and the ability to perform the injection right after the anesthesia . . . these may have unique benefits,” he concluded.
Different probes for different folks
Jayanth Sridhar, MD, then looked at Lens and Peripheral Retinal Relationships during Vitrectomy: Comparison of 23-, 25- and 27-gauge Vitrectomy and Curved Endolaser Probes. This paper was based on a 1991 study by Smiddy et al. which identified the relationship between vitrectomy instruments and the phakic lens in the eye — this study re-examines those relationships using smaller instruments. As it turns out, the gauge of the instrument did not matter. However, they found that curved instruments could come closer to the ora serrata (180 degrees from the entry site). Another interesting finding was that in eyes with an axial length of ≥25mm, the vitrector can cross the ora serrata.
“For me, it helped reinforce that we can cross a lot more than maybe we intuitively think . . . we’re always so concerned with not bumping the crystalline lens and avoiding complications, but it was very helpful to get that confidence, especially in eyes where we want to do peripheral work, where we don’t need to take the crystalline lens, and we can do a lot more crossing over with better visualization of the vitreous,” concluded Dr. Sridhar.
Up next was Christopher Henry, MD, to discuss suprachoroidal injections. “These injections are not difficult to perform, 98% of baseline injections were able to be completed successfully; 71% with the short needle; 29% with the longer 1100 µm needle. So, don’t be nervous about these injections, they’re easy to learn and I think that in the future, this is going to be a promising technology,” shared Dr. Henry.
Shiny and brand new
Finally, a new device made its virtual debut at ASRS 2020: The PINNACLE 360™ 25-gauge Scleral Fixation Forceps from Bausch + Lomb (Bridgewater, New Jersey, USA). Developed in conjunction with Arizona retina specialist Daniel Adelberg, MD, these forceps aid in the placement of scleral-sutured posterior chamber intraocular lenses (IOLs) – a procedure that has played an important role in the treatment of aphakic eyes without capsule support.
