The role and mechanisms of intraocular infusion during microinvasive guillotine and ultrasonic vitrectomy
DOI: 10.32364/2311-7729-2023-23-1-66-70
B.M. Aznabaev1,2, T.R. Mukhamadeev1,2, T.I. Dibaev1,2, T.N. Ismagilov1,2
1Bashkir State Medical University, Ufa, Russian Federation
2CJSC Optimedservis, Ufa, Russian Federation
Maintaining tone of the eyeball and stable intraocular pressure (IOP) during vitrectomy is an important issue associated with the safety of intraocular structures. As the vitreous body is removed, it is gradually replaced with a balanced salt solution, which leads to a decrease in viscosity of the vitreous chamber content and may contribute to changes of the hydrodynamic parameters during surgical procedures. Thus, it is necessary to ensure controlled operation and coordination of the infusion and aspiration modules used in the microsurgical system. Commonly, the imbalance between the aqueous humor inflow and outflow during vitrectomy may cause either a decrease or increase in IOP. The gravity infusion surgical systems cannot compensate for sudden changes in the hydrodynamic parameters during eye surgery, and, as a result, significant fluctuations in IOP may occur. Thus, it is important to develop algorithms for forced infusion that will ensure a more precise control of the infusion flow. The review describes various forced infusion mechanisms and key approaches to their use, as well as their effectiveness and safety patterns, highlighted in the experimental and clinical studies.
Keywords: vitrectomy, intraocular pressure, hydrodynamic balance, forced infusion, microsurgical systems, ultrasonic vitrectomy.
For citation: Aznabaev B.M., Mukhamadeev T.R., Dibaev T.I., Ismagilov T.N. The role and mechanisms of intraocular infusion during microinvasive guillotine and ultrasonic vitrectomy. Russian Journal of Clinical Ophthalmology. 2023;23(1):66–70 (in Russ.). DOI: 10.32364/2311-7729-2023-23-1-66-70.
About the authors:
Bulat M. Aznabaev — Dr. Sc. (Med.), Professor, Professor of the Ophthalmology Department with IAPE Course, Bashkir State Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; Director General, CJSC Optimedservis; 8, 50 let SSSR str., Ufa, 450059, Russian Federation; ORCID iD 0000-0003-1796-8248.
Timur R. Mukhamadeev — Dr. Sc. (Med.), Head of the Ophthalmology Department with IAPE Course, Bashkir State Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; Deputy Director General for Research and Clinical Activities, CJSC Optimedservis; 8, 50 let SSSR str., Ufa, 450059, Russian Federation; ORCID iD 0000-0003-3078-2464.
Tagir I. Dibaev — C. Sc. (Med.), Head of the Ophthalmology Department with IAPE Course, Bashkir State Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; Deputy Director General for Research and Clinical Activities, CJSC Optimedservis; 8, 50 let SSSR str., Ufa, 450059, Russian Federation; ORCID iD 0000-0002-7448-6037.
Timur N. Ismagilov — postgraduate student of the Ophthalmology Department with IAPE Course, Bashkir State Medical University; 3, Lenin str., Ufa, 450008, Russian Federation; junior researcher of the Department for Research Coordination, CJSC Optimedservis; 8, 50 let SSSR str., Ufa, 450059, Russian Federation; ORCID iD 0000-0003-4132-4979.
Contact information: Tagir I. Dibaev, e-mail: dibaev@yandex.ru.
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interests.
Received 15.06.2021.
Revised 08.07.2021.
Accepted 02.08.2021.
2. Charles S. Fluidics and cutter dynamics. Dev Ophthalmol. 2014;54:31–37. DOI: 10.1159/000360446.
3. Machemer R., Norton E.W.D. A new concept for vitreous surgery: 3. Indications and results. Am J Ophthalmol. 1972;74(6):1034–1056. DOI: 10.1016/0002-9394(72)90720-9.
4. Saxena S., Meyer C.H., Ohji L.A. Vitreoretinal Surgery. New Delhi: Jaypee Brothers Medical Publishers; 2012.
5. O’Malley C., Heintz R.M Sr. Vitrectomy with an alternative instrument system. Ann Ophthalmol. 1975;7(4):585–588, 591–594. PMID: 1147502.
6. De Oliveira P.R., Berger A.R., Chow D.R. Vitreoretinal instruments: vitrectomy cutters, endoillumination and wide-angle viewing systems. Int J Retina Vitreous. 2016;2:28. DOI: 10.1186/s40942-016-0052-9.
7. Steel D.H., Charles S. Vitrectomy fluidics. Ophthalmologica. 2011;226 Suppl 1:27–35. DOI: 10.1159/000328207.
8. Magalhães O.Jr., Maia M., Maia A. et al. Fluid dynamics in three 25-gauge vitrectomy systems: principles for use in vitreoretinal surgery. Acta Ophthalmol. 2008;86(2):156–159. DOI: 10.1111/j.1600-0420.2007.00988.x.
9. Abulon D.J., Charles M., Charles D.E. Globe stability during simulated vitrectomy with valved and non-valved trocar cannulas. Clin Ophthalmol. 2015;9:1745–1752. DOI: 10.2147/OPTH.S86326.
10. Charles S., Calzada J., Wood B. Vitreous microsurgery. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2012.
11. Азнабаев Б.М. Ультразвуковая хирургия катаракты — факоэмульсификация. М.: Парето-Принт; 2016. [Aznabaev B.M. Ultrasound cataract surgery — phacoemulsification. M.: Pareto-Print; 2016 (in Russ.)].
12. Канюков В.Н., Канюков В.И. Техническое применение офтальмологической операционной системы DORC Associate в офтальмологической практике: методическое указание. Оренбург; 2009. [Kanyukov V.N., Kanyukov V.I. Technical application of the DORC Associate ophthalmic operating system in ophthalmic practice: guidelines. Orenburg; 2009 (in Russ.)].
13. Sugiura Y., Okamoto F., Okamoto Y. et al. Intraocular pressure fluctuation during microincision vitrectomy with constellation vision system. Am J Ophthalmol. 2013;156(5):941–947.e1. DOI: 10.1016/j.ajo.2013.06.016.
14. Moorhead L.C., Gardner T.W., Lambert H.M. et al. Dynamic intraocular pressure measurements during vitrectomy. Arch Ophthalmol. 2005;123(11):1514–1523. DOI: 10.1001/archopht.123.11.1514.
15. Quigley H.A., McKinnon S.J., Zack D.J. et al. Retrograde axonal transport of BDNF in retinal ganglion cells is blocked by acute IOP elevation in rats. Invest Ophthalmol Vis Sci. 2000;41(11):3460–3466. PMID: 11006239.
16. Kim M., Kim S., Kwon H. et al. Association between choroidal thickness and ocular perfusion pressure in young, healthy subjects: Enhanced depth imaging optical coherence tomography study. Investig Ophthalmol Vis Sci. 2012;12(53):7710–7717. DOI: 10.1167/iovs.12-10464.
17. Khng C., Packer M., Fine I. et al. Intraocular pressure during phacoemulsification. J Cataract Refract Surg. 2006;32(2):301–308. DOI: 10.1016/j.jcrs.2005.08.062.
18. Alder V.A., Cringle S.J. Vitreal and retinal oxygenation. Graefes Arch Clin Exp Ophthalmol. 1990;228(2):151–157. DOI: 10.1007/BF00935725.
19. Bill A., Sperber G.O. Control of retinal and choroidal blood flow. Eye (Lond). 1990;4(2):319–325. DOI: 10.1038/eye.1990.43.
20. Ковальчук А.Г. Теоретическое обоснование нового способа диагностики микроциркуляторной ишемии цилиарного тела. Глаукома. 2017;16(4):69–78. [Kovalchouk A.G. Theoretical justification of a new method in ciliary body microcirculatory ischemia diagnostics. National Journal glaucoma. 2017;16(4):69–78 (in Russ.)].
21. Кунин В.Д., Редид А.А. Перфузионное давление глаза и его значение в течении первичной открытоугольной глаукомы. Точка зрения Восток-Запад. 2016;3:60–63. [Kunin V.D., Redid A.A. Perfusion pressure of the eye and its value in the course of primary open-angle glaucoma. Tochka zreniya Vostok-Zapad. 2016;3:60–63 (in Russ.)].
22. Cioffi G.A., Granstam E., Alm A. Ocular circulation. In: Adler’s physiology of the eye. 10th ed. Kaufmann P.L., Alm A., eds. St. Louis, London: Mosby; 2003.
23. Levin L.A., Kaufman P.L. Adler’s Physiology of the Eye: Clinical Application. 11th ed. New York: Saunders/Elsevier; 2011.
24. Rossi T., Querzoli G., Angelini G. et al. Ocular perfusion pressure during pars plana vitrectomy: a pilot study. Invest Ophthalmol Vis Sci. 2014;55(12):8497–8505. DOI: 10.1167/iovs.14-14493.
25. Казиев С.Н., Борзенок С.А., Сабурина И.Н. и др. Эндоиллюминация в ходе витреальной хирургии — эволюция вопроса и особенности применения на современном этапе. Практическая медицина. 2013;70(9):10–12. [Kaziev S.N., Borzenok S.A., Saburina I.N. et al. Endoillumination in the course of vitreal surgery — history of the issue and administration details in the modern period. Prakticheskaya medicina. 2013;70(9):10–12 (in Russ.)].
26. Hayreh S.S. Blood flow in the optic nerve head and factors that may influence it. Prog Retin Eye Res. 2001;20(5):595–624. DOI: 10.1016/S1350-9462(01)00005-2.
27. Pillunat L.E., Anderson D.R., Knighton R.W. et al. Autoregulation of human optic nerve head circulation in response to increased intraocular pressure. Exp Eye Res. 1997;5(64):737–744. DOI: 10.1006/exer.1996.0263.
28. Sehi M., Flanagan J., Zeng L. et al. Anterior optic nerve capillary blood flow response to diurnal variation of mean ocular perfusion pressure in early untreated primary open-angle glaucoma. Invest Ophthalmol Vis Sci. 2005;46(12):4581–4587. DOI: 10.1167/iovs.05-0209.
29. Charles S. An engineering approach to vitreoretinal surgery. Retina. 2004;24(3):436–444. DOI: 10.1097/00006982-200406000-00015.
30. Williamson T.H. Vitreoretinal surgery. 2nd ed. Heidelberg: Springer; 2013.
31. Agarwal A., Apple D.J., Agarwal S. et al. Air pump to prevent surge. In: Agarwal A., Agarwal S., Sachdev M.S. et al., eds. Phacoemulsification, Laser Cataract Surgery and Foldable IOLs. 2nd ed. New Delhi, India: Jaypee Brothers, 2000:624–626.
32. Nazarifar N.S. Surgical cassette and consumables for combined ophthalmic surgical procedure. U.S. Patent No. 6,561,999 B1. 2003:1–14.
33. Awh C.C. Stellaris PC: Next-generation. (Electronic resource.) URL: https://retinatoday.com/articles/2011-mar-supplement/stellaris-pc-next-generation-technology (access date: 14.06.2021).
34. Lai T.Y. Machines and cutters: Stellaris PC. Dev Ophthalmol. 2014;54:8–16. DOI: 10.1159/000360443.
35. Huculak J., Martin M., Zica M. Retinal surgery. U.S. Patent No. 6,561,999 B1. 2016:1–14.
36. Kim Y.J., Park S.H., Choi K.S. Fluctuation of infusion pressure during microincision vitrectomy using the constellation vision system. Retina. 2015;35(12):2529–2536. DOI: 10.1097/IAE.0000000000000625.
37. Falabella P., Stefanini F.R., Lue J.L. et al. Intraocular pressure changes during vitrectomy using Constellation Vision System’s intraocular pressure control feature. Retina. 2016;36(7):1275–1280. DOI: 10.1097/IAE.0000000000000911.
38. Yang H.S., Yun Y., Park J. et al. In vivo intraocular pressure monitoring during microincision vitrectomy with and without active control of infusion pressure. Eur J Ophthalmol. 2017;27(5):601–606. DOI: 10.5301/ejo.5000956.
39. Murray T., Layton A., Tong K. et al. Transition to a novel advanced integrated vitrectomy platform: Comparison of the surgical impact of moving from the Accurus vitrectomy platform to the Constellation Vision System for microincisional vitrectomy surgery. Clin Ophthalmol. 2013;7:367–377. DOI: 10.2147/opth.s35603.
40. Kuntz J., Vijfvinkel G. Irrigation/aspiration system, cartridge, pump unit, surgical machine, method for controlling. U.S. Patent No. 10,238,789 B2. 2019:1–16.
41. Rossi T., Querzoli G., Gelso A. et al. Ocular perfusion pressure control during pars plana vitrectomy: testing a novel device. Graefes Arch Clin Exp Ophthalmol. 2017;255(12):2325–2330. DOI: 10.1007/s00417-017-3799-2.
42. Rossi T., Querzoli G., Gelina G.B. Infusion pressure control system. World Intellectual Property Organization. Patent No. WO 2019/012494 Al. 2019:1–26.
43. Minami M., Oku H., Okuno T. et al. High infusion pressure in conjunction with vitreous surgery alters the morphology and function of the retina of rabbits. Acta Ophthalmol Scand. 2007;85(6):633–639. DOI: 10.1111/j.1600-0420.2007.00919.x.
44. Michelson G., Groh M., Langhans M. Perfusion of the juxtapapillary retina and optic nerve head in acute ocular hypertension. Ger J Ophthalmol. 1996;5(6):215–321. PMID: 9479511.
45. Uchida A., Shinoda H., Matsumoto C. et al. Acute visual field defect following vitrectomy determined to originate from optic nerve by electrophysiological tests. Case Rep Ophthalmol. 2012;3(3):396–405. DOI: 10.1159/000345507.
46. Koppel T. Liquid management in an ophthalmological device. World Intellectual Property Organization. Patent No. WO 2018/083179 AI. 2019:1–70.
47. Pastor-Idoate S., Bonshek R., Irion L. et al. Ultrastructural and histopathologic findings after pars plana vitrectomy with a new hypersonic vitrector system. Qualitative preliminary assessment. PLoS One. 2017;12(4):e0173883. DOI: 10.1371/journal.pone.0173883.
48. Stanga P.E., Pastor-Idoate S., Zambrano I. et al. Performance analysis of a new hypersonic vitrector system. PLoS One. 2017;12(6):e0178462. DOI: 10.1371/journal.pone.0178462.
49. Aznabaev B., Dibaev T., Mukhamadeev T. et al. Twenty-five gauge ultrasonic vitrectomy. Retina. 2020;40(7):1443–1450. DOI: 10.1097/iae.0000000000002863.
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