Upgrades to Bausch + Lomb’s Stellaris Elite Vision Enhancement System were designed to deliver precise control and increased efficiency to a wide range of cataract and retina procedures, says Anthony Wallace, vice president and general manager of US Surgical at Bausch + Lomb. Specifically, the upgrades increased the system’s maximum vacuum setting from 600 mmHg to 660 mmHg, improved the removable valve caps in the trocar/cannula system, and increased light pipe rigidity.

“I’m always looking for ways to be more efficient,” says Jaime Gaitan, MD, vitreoretinal surgeon and partner at Associated Retina Consultants in Phoenix, Arizona, who provided feedback during the product’s development. “Now that the Stellaris Elite has been upgraded, I’m more efficient with vitrectomy across multiple kinds of cases due to the higher vacuum.”

The Stellaris Elite system is designed to support the entire spectrum of cataract and vitrectomy surgeries, including both posterior and anterior segment procedures.

INCREASING SPEED

The system’s maximum vacuum increase enables a 10% boost in vacuum capabilities and up to an 8% increase in vitreous removal efficiency. According to Wallace, this upgrade was made because retina specialists continue to look for improved efficiency and stability to support a broad spectrum of surgical maneuvers. This has become especially important as more surgeons are transitioning to smaller gauge surgery procedures.

The upgrade provides higher flow rates and better tissue engagement with Bausch + Lomb’s Bi-Blade vitrectomy cutter technology, as well as a wide variety of active aspiration accessories used with the Stellaris Elite platform.

“With a Bi-Blade cutter and increased vacuum, I can remove the vitreous gel with greater control and efficiency than ever before,” says Sunir J. Garg, MD, FASRS, FACS, professor of ophthalmology in the retina service of Wills Eye Hospital, Thomas Jefferson University, and partner at Mid Atlantic Retina, both in Philadelphia. “This is true for all gauge sizes. The 23-gauge system is so fast at removing vitreous that I actually use the 23-gauge more than I have in a while.” Dr. Garg uses the upgraded system as his primary vitrectomy platform.

Previously, Dr. Gaitan, who works primarily at ambulatory surgery centers, would gravitate toward a 23-gauge product when desiring efficiency. “With the upgrades, I can do the bulk of my cases with a 25 gauge, without feeling the need for a larger gauge,” he says. “I can remove vitreous much faster in all types of cases, including retinal detachments, diabetic cases, and macular puckers.”

PRIORITIZING INDEPENDENCE

The changes made to the removable valve caps in the trocar/cannula system deliver a 33% increase in the central thickness of the valve and a 27% reduction in each segment of the tri-slit profile.

Wallace says this upgrade was made to improve fluidic stability in the eye while still allowing for the easy transfer of instruments, including silicone tipped devices such as soft-tipped cannulas and diamond dusted membrane scrapers commonly used in small-gauge retina procedures.

“The system now delivers the fluidic predictability that retina specialists desire through all stages of a cannulated retina procedure,” Wallace says.

Says Dr. Garg, “The caps over the Bausch + Lomb cannulas give me independent control over the valves,” he says. “All vitrectomy systems occasionally have valves that leak. The modified valves retain fluid well and allow me to pass instruments in and out of the eye with ease.”

Thanks to the newer valve caps, Dr. Gaitan says it’s much easier to switch instruments from lasers to forceps to soft tips.

MORE DURABILITY

The upgrades also included an increase in light pipe rigidity. In 2020, the design of all Bausch + Lomb 25-gauge endoilluminators were altered to increase rigidity by 146%. In late 2022, the 25-gauge endoilluminators saw a further 74% increase in rigidity for additional support when manipulating the globe.

“As we continue to move to smaller gauges for less invasive procedures, more rigid instruments are desired,” Wallace says. “This allows retina specialists to confidently maneuver instruments in the eye, especially when accessing the far periphery.”

Having a stiffer light pipe makes surgery easier for Dr. Garg. “When using other light pipes, sometimes I have to withdraw the light pipe, stabilize it with my finger, and use the tip of the light pipe in order to move the eye,” he says. “With the new light pipe’s increased stiffness, I no longer have to do this. As a result, I can keep my hand in a more comfortable position.”

The increased efficiency of vitreous removal has shortened Dr. Garg’s surgery time. When doing 8 to 10 cases a day, saving even a few minutes per case adds up. That’s less stress on his body, particularly his back.

Dr. Garg does most of his surgeries with 25-gauge vitrectomy. “Light pipes can bend or flex, particularly when trying to rotate the eye,” he says. “The recent iterations of the light pipe have resulted in a dramatic increase in light pipe rigidity. This has given me more control over eye positioning during surgery.”

BETTER OUTCOMES

All existing Stellaris Elite users have immediate access to the upgrades. The vacuum increase is included in a regular software upgrade. The valve and endoilluminator improvements are included in posterior packs which are available to order.

“This is my primary machine for all of my retina surgeries,” Dr. Garg says. “Some of our operating room nurses say it’s the easiest system to set up and use. Our surgery center appreciates its cost effectiveness, and I appreciate how well it performs for my patients.”

Dr. Gaitan uses the system for most of his cases. “I don’t have to worry about switching to another system,” he says.

Whenever a surgeon can do a procedure with greater confidence and precision, it will hopefully translate into a better patient experience, Dr. Garg concludes. The faster cutters with greater control over cut rates may cause less traction on the peripheral retina, and all patients benefit from surgery being done safely and efficiently.

“The longer a case, the higher the risk,” Dr. Gaitan says. “By being more efficient, you improve safety because you decrease the amount of time you’re in the eye.” When doing 7 to 10 cases a day, he’s about 10% faster when using the system. RP