Moving Pediatric Retina Cases to Small-gauge Technology
The CONSTELLATION Vision System represents a significant advance in the application of new technology.
By Antonio Capone Jr.,MD
Micro-incision vitrectomy surgery (MIVS) has been at the forefront of vitreoretinal surgery for some time now. One might imagine that, logically, small-gauge surgery would be suitable for pediatrics; if the instruments are smaller, they must be better for smaller eyes. A variety of factors, however, have limited the application of small-gauge technology to pediatric retinal surgery.
One limitation is that small-gauge instruments have not been as efficient at eliminating or removing the vitreous. A more significant limitation to pediatric surgery has been the flex characteristics that made it difficult or impossible to work in the far peripheral retina—where most of the pathology, especially in retinopathy of prematurity (ROP) cases, lies.
The new 25+ vitrectomy probe on the CONSTELLATION Vision System (Alcon Laboratories, Inc.) has a stiffening sleeve around the shaft of the vitrector, addressing much of the flexion limitations of small-gauge instruments. This, combined with the improved fluidics on the CONSTELLATION Vision System lets us choose a small-gauge approach without having to compromise with regard to flexion or efficiency in vitreous removal. Furthermore, the 25+ vitrector has the port closer to the tip, similar to the Alcon 23-gauge vitrector.
RADIOFREQUENCY IDENTIFICATION (RFID)
A major advantage of the new CONSTELLATION System is the radio frequency identification (RFID) feature, which automatically recognizes Alcon devices equipped with this technology when connected to the CONSTELLATION, Xenon Illuminator, or embedded PUREPOINT Laser (Alcon Laboratories, Inc.). This feature allows for preset settings and reduces surgeon dependence on operating room staff for the procedure set-up.
I have been favorably impressed with the PUREPOINT Laser. The theme of greater surgeon control is repeated in the foot pedal design, which allows control of standby-to-ready and power settings. The laser itself is well powered and efficient. The embedded system also allows the scrub nurse to access and modify the settings straight from the screen of the CONSTELLATION System, if desired. Voice confirmation for parameter changes is another feature which offers independence and procedure control to the surgeon.
High-speed Cutting and Variable Duty Cycle
The higher cutting rates on the CONSTELLATION Vision System offer the clear advantage of vitreous removal with very little traction. The "shave" setting facilitates work close to the retina with what is, in my opinion, a lower risk of iatrogenic retinal breaks. The variable duty cycle capabilities on the CONSTELLATION System are smoother and more seamless, enabling easy, intuitive alteration from a core vitrectomy to a peripheral vitrectomy to shaving of mobile retina.
In summary, I am looking forward to using the CONSTELLATION System to transition more of my pediatric surgical cases to small-gauge technology.
Antonio Capone Jr., MD, is a Clinical Professor of Biomedical Sciences at Oakland University, in Auburn Hills, MI, Co-Director of the Vitreoretinal Fellowship Training Program for Associated Retinal Consultants, in Royal Oak, MI, and Director of ARC's Vision Research Foundation. He reports that he is a member of Alcon's Retinal Advisory Committee. Dr. Capone may be reached at firstname.lastname@example.org.