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Luiz Henrique Lima, Vinicius Saraiva, ; Dual Port Cutter Vitrectomy for Dense Vitreous Hemorrhage: Preliminary Study. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5112.
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© ARVO (1962-2015); The Authors (2016-present)
The purpose of this study was to compare the impact of a 180 degrees dual port (DP) cutter on dense vitreous hemorrhage removal and the advantages of having an additional cutter tip port over the current SP cutter technology.
Thirty-six consecutive eyes of 36 patients underwent bulky vitrectomy surgery by six surgeons using the 180 degrees DP (18 eyes) and the SP (18 eyes) cutters. With both study cutters, the bulky vitrectomy was performed at 2,500 cuts per minute (CPM) and at vacuum level of 300 mmHg. The 180 degrees DP cutter tip was fabricated from a standard 23-gauge SP cutter tip with the same sized port. The second port of 0.020-inch diameter port was machined at the distal end of the tip and 180 degrees opposite of the original port. Vitreous hemorrhage was classified as dense when the red reflex was absent without visualization of any retinal structure. The main etiologies for dense vitreous hemorrhage were diabetic retinopathy (16/36; 44.4%), retinal tears (9/36; 25%), neovascularization from branch or central retinal vein occlusion (7/36; 19.5%), sickle cell retinopathy (3/36; 8.3%), macroaneurism (1/36; 2.8%). The surgeons graded the 180 degrees DP cutter tip as better, worse, or the same as the standard SP tip for bulky vitrectomy. Mean operative time (specifically for bulky vitrectomy), and intraoperative and postoperative complications were recorded.
For bulky vitreous removal, all surgeons (100%) classified the 180 degrees DP cutter tip as better than the SP cutter. Regarding safety, most surgeons (76%) considered the 180 degrees DP cutter as safe as the standard SP cutter. Mean bulky vitrectomy time was 10.6 minutes and 17.2 minutes for the 180 degrees DP cutter and the SP cutter, respectively. Transient postoperative hypotony was the most common complication (180 degrees DP cutter: 12.3%; SP cutter: 11.9%), resolving without treatment in both study groups. Only 3 phakic eyes (180 degrees DP cutter: 2.8%; SP cutter: 5.5%) developed cataracts. None of the study patients developed retinal break or detachment, choroidal effusion, postoperative endophthalmitis, or glaucoma.
The 180 degrees DP cutter system seems to be safe and effective for dense vitreous hemorrhage removal, and may allow the surgeon to perform bulky vitrectomy more quickly. Further studies are needed to compare both 180 degrees DP and SP cutters in larger series.
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