Carl C. Awh, MD (Nashville, TN)*

PURPOSE:

To demonstrate the efficacy of new devices for vitreoretinal surgery, including the following: an improved chandelier illuminator, “one-step” insertion cannulas for 23- and 20-gauge vitrectomy, an intraocular fluid micro-injector, and an improved endoillumination source. To compare these devices to previously existing devices.

METHODS:

The following devices were used during a variety of vitrectomy cases: (1) A chandelier illuminator with a sliding fiberoptic within a sharped metal cannula, allowing “one-step” insertion. The length of exposed fiberoptic is adjustable. (2) An integrated trocar/cannula for 23- and 20-gauge vitrectomy, consisting of a flexible cannula pre-loaded over a flattened blade-like trocar, allowing “one-step” insertion of the cannula. (3) A microinjector for surgeoncontrolled delivery of dyes or drugs. (4) An improved endoillumination source, delivering more light through thinner and more flexible fiberoptics.

RESULTS:

The “one-step” chandelier is easier to insert than previous chandelier designs. The ability to adjust the amount of exposed fiberoptic allows the surgeon to vary the area of illumination and to eliminate glare during airfluid exchange. The “one-step” cannulas eliminate the need for a separate stab incision and cannula insertion for 23- and 20-gauge vitrectomy, while
preserving the benefits of blade-created wound construction. The intraocular microinjector allows controlled delivery of fluids, minimizing the volume of ICG necessary to achieve useful staining of the ILM and allowing precise delivery of other dyes and drugs. The improved endoillumination source enables brighter illumination levels through existing devices, and well as the ability to create devices with smaller, more flexible optical fibers. This improves the flow of illuminated infusion cannulas and reduces the stiffness inherent in many fiberoptic devices. No device-related complications occured in over 50 cases.

CONCLUSION:

The new devices improve the surgeon’s ability to treat complex vitreoretinal pathology by improving the quality of illumination, the control of intraocular fluid injection, and the ease of insertion of both 23- and 20-gauge cannulas.
* Financial interest disclosed