Alcon designed its new Hypervit dual-blade beveled vitrectomy probe to enhance stability and control during microincisional vitrectomy. The probe allows surgeons to modify duty cycle and to control flow independent of vacuum and cut rate, creating stable, closed-system intraocular surgeries.

The Hypervit, with its dual-pneumatic drive, can perform 20,000 cuts per minute with a continuously open port, and it is available in 25+ and 27+ gauge sizes. The probe is the newest upgrade to Alcon’s Constellation Vision System and the latest evolution of its Ultravit probes. The first Ultravit debuted in 2008 with 5,000 cuts per minute for use in 20, 23+, and 25+ gauge sizes.

“The probe is a great example of how Alcon created smaller gauge sizes at higher cut rates, while ensuring that we delivered on customer expectations of consistent flow and duty cycle,” says Jim Di Filippo, vice president and general manager of US Surgical at Alcon.

Maria H. Berrocal, MD, director and vitreoretinal surgeon at Berrocal & Associates, who tested the 27+ gauge Hypervit probe as a prototype, says its beveled tip is superb for more complicated cases such as retinal detachments, tractional retinal detachments, and peeling membranes, as well as simpler cases like macular holes and epiretinal membranes. “Its features make it very efficient to remove the vitreous while causing minimal traction on the underlying retina,” she says.

John W. Kitchens, MD, partner at Retina Associates of Kentucky and advisor and consultant for Alcon, says the biggest advantage of dual-blade technology is the speed at which it removes the vitreous. “The cutter port is open more than 90% of the time compared to traditional cutters, which struggle to be open 50% of the time at higher cut rates,” he says. “The advantage of the Hypervit is that it reduces fluidic turbulence with a continuously open port. No surge or transient hypotony occurs.”

HOW IT WORKS

The Hypervit probe features a dual-blade design that cuts twice for each cycle, allowing it to remove the vitreous at 20,000 cuts per minute. “This enhances stability and reduces fluidic turbulence in the eye,” says Josh Anderson, MBA, head of sales and marketing for US Surgical Retina at Alcon.

Says Dr. Berrocal, “The dual-blade design allows for cutting the vitreous into smaller bites, which reduces traction significantly.” The dual-pneumatic technology assists in providing a continuously open port, leading to improved vitreous flow and reduction in pulsatile traction when compared to previous generations. “The constantly open port increases flow significantly without having to increase vacuum, allowing for safe and efficient vitreous and membrane management,” Dr. Berrocal adds.

The beveled tip design, which is now standard on Alcon’s new technology probes, moves the port closer to the retina’s surface, enhancing access to the tissue plane, Anderson says. Combined with the Constellation’s intraocular pressure control and valved cannulas, the probe provides a stable and controlled intraocular system.

“The beveled tip allows for the probe to be used as a pick to lift membranes and tissue and allow for shaving tissue from the retina’s surface,” says Dr. Berrocal.

USER FRIENDLY

Based on the software features built into the Constellation platform, existing users already have the capability to use the Hypervit’s new technology.

“The learning curve is essentially nonexistent in the same gauge that a surgeon is accustomed to,” Dr. Berrocal says. “When transitioning to a smaller gauge, it removes vitreous as efficiently as larger gauge vitrectors, so there’s a seamless transition.”

Adds Dr. Kitchens, “The experience is very similar to the current Alcon cutter hand piece. It does require a software update, but the Constellation interface is the same.”

IMPROVING SURGICAL OUTCOMES

Ultimately, the Hypervit probe allows for reduced vitreous removal times with reduced traction. “This minimizes potential complications of light and pressure toxicity or trauma to the retina, as well as movement of the patient,” Dr. Berrocal says. “Using the smallest gauge possible has the advantage of smaller, better sealing sclerotomies. This results in reduced hypotony in the perioperative period and on day one and reduced post-op hemorrhages on day one.1 Both hypotony and hemorrhage on day one are among the most common complications in diabetic vitrectomies. Also, reduced traction on the retina and vitreous base reduces the incidence of iatrogenic breaks.”

The main limitations for the widespread adoption of the 27+ gauge vitrectomy platform is the slower removal of vitreous gel due to the reduced flow. “The Hypervit has removed this limitation, since it performs as efficiently as the 25+ gauge, and the 25+ gauge Hypervit as efficiently as the 23 gauge,” Dr. Berrocal says. “Therefore, there are no longer any limitations for adopting the smallest gauges possible in vitrectomy. This will result in better sealing sclerotomies, improved surgical times, more streamlined surgeries with reduced need for ancillary instrumentation, as well as reduced traction on the retina and potentially reduced iatrogenic breaks.”

FINAL THOUGHTS

Dr. Berrocal says that she can perform nearly every case with this probe. Dr. Kitchens adds that he believes Hypervit technology will become a mainstay for retina specialists, much like smaller gauge surgery and valved cannulas. “For surgeons considering a change in gauge from larger to smaller, it will hasten the transition,” he says. “Personally, I will be more apt to transition to 27+ gauge instruments (from 25+ gauge) thanks to this advancement.” RP

REFERENCE

1. Khan MA, Kuley A, Riemann CD, et al. Long-term visual outcomes sand safety profile of 27-gauge pars plana vitrectomy for posterior segment disease. Ophthalmology. 2018;125(3):423-431.