DORC’s new EVA NEXUS, a complete surgical system for phacovitrectomy surgery, provides improved surgical efficiencies — which may reduce the risk for iatrogenic complications — and improves usability compared to its predecessor, the EVA system. “All of its new innovations were inspired by surgeons,” says Pierre Billardon, CEO at DORC International in Zuidland, Netherlands.

EVA NEXUS is a complete ophthalmic surgical system for cataract, retina, and combined surgery. The platform is built on DORC’s unique Vacuflow VTi technology, a proprietary pump system designed to combine control, efficiency, and precision as it allows surgeons to choose between vacuum or flow mode during surgery. EVA NEXUS includes a range of new features such as Smart IOP for IOP stability, the EVA INICIO microinjection system, and the next generation 2-dimensional cutter (TDC) called the TDC Veloce.

A CLOSER LOOK

Smart IOP is a new infusion mode that has been designed to deliver superior anterior and posterior chamber stability, Billardon says. Against a chosen base pressure, EVA NEXUS compensates automatically for expected pressure loss in Smart IOP instruments, resulting in a constant IOP during surgery.

“Smart IOP allows for real-time IOP monitoring, which adds safety in terms of ocular perfusion and makes inserting liquids such as perfluoro-n-octane easier by not having to manipulate IOP,” says Gaurav K. Shah, MD, a partner and vitreoretinal surgeon at the Retina Institute in St. Louis, Missouri, who contributed input during the product’s development.

“All of the innovations in fluidics, including Smart IOP, are based around safety and patient outcomes,” says Jorge Fortun, MD, medical director and retina surgeon at Bascom Palmer Eye Institute in Palm Beach Gardens, Florida, who also helped guide the product’s development. “By controlling IOP, we can help prevent vision loss related to IOP spikes or to hypotony in terms of developing intraoperative choroidal detachments,” he says. “Staying dedicated to the precise control of flow may lead to less iatrogenic breaks, tears, and retinal damage.”

EVA NEXUS is the first surgical system approved for subretinal injection, Billardon says. Its Inicio system was designed specifically for EVA NEXUS to deliver system-controlled ±1 psi control of injections of less than 1 mL, with accompanying cannulas for subretinal injection.

Another benefit of EVA NEXUS is that it provides surgeons with precision and control of liquid delivery to the subretinal space. “We’re entering an area of vitreoretinal surgery in which gene delivery in the subretinal space is becoming more of a therapeutic option,” says Dr. Fortun.

DORC’s new EVA trocar cannula system includes improvements such as an easy-to-connect and secure Push-Fit infusion line as well as a new cannula design for smooth insertion and improved retention in the sclera, Billardon says.

The Push-Fit connection eliminates the need for surgeons to take an additional surgical step when placing the trocar, thereby improving efficiencies and potentially reducing surgery time, Billardon continues. In fact, the new design has been shown¹ to reduce the need to suture sclerotomies, potentially saving surgical time, Billardon says.

According to Dr. Shah, “The new trocars have a chamfered cannula transition which minimizes entry exertion force. The high flow infusion system significantly reduces turbulence in the globe.”

The trocars have a laser etched design that allows them to remain in the sclera. This has decreased the number of trocars being inadvertently removed during surgery, Dr. Shah says, and helps with wound stability and closure. The new trocars don’t require valve removal, which is a convenience.

CLINICAL APPLICATIONS

The EVA NEXUS is optimized for high-volume surgery. Its control and precision are designed to meet the demands of complex surgery. “With a universal cartridge, dual irrigation, infusion lines, and dual-mode fluidics, the system is well adapted to meet the needs of the growing proportion of retina surgeries that combine cataract extraction,” Billardon says.

Dr. Shah uses the system for vitreoretinal surgery in 23, 25, and 27 gauges. “It is highly efficient in all gauges, which gives me and the operating room staff versatility,” he says.

Dr. Fortun uses the system for all vitrectomies. “The system allows for precise flow control, which makes it great for operating in retinal detachments when the retinal tissue is mobile and in tractional retinal detachments where increased safety is desired,” he says.

EASE OF USE

Like its predecessor, EVA NEXUS is equipped with an intuitive touch screen interface and comes with a wireless, dual linear footswitch. The footswitch, with integrated laser function and various programmable functions, can be customized to a surgeon’s needs.

Dr. Shah says the new Nexus system is easier for surgeons to use because it has one laser integrated foot pedal that allows for multiple programmable options. This gives him full control at the foot switch.

Furthermore, Dr. Shah says the new system is easier for nurses to use because it has a monitor that can be adjusted horizontally and vertically, it has front and rear brakes, and it has a balanced salt solution (BSS) bottle level detector that indicates when BSS gets low. Effective infusion can be sourced by a BSS bottle or bag because infusion is managed in the machine pump and not in a snorkeled glass bottle.

Dr. Fortun notes that the handle of the VELOCE vitrectome has been redesigned to be more ergonomic and allows for a more comfortable feel, resulting in fewer vibrations during vitrectomy. The surgical interface has been redesigned to create greater ease for surgical assistants in transitioning between phases of vitrectomy. RP

REFERENCE

1. Vickerman J, Tewari A. Minimizing sclerotomy suture rates in 23-gauge vitrectomy. Poster presented at: The Retina Society 2021 annual meeting; September 30, 2021, Chicago, IL.