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Bubbles from vitrector pose challenges for surgeons
The bubbles can stick to structures such as the corneal endothelium and crystalline lens during vitrectomy.
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An advanced microsurgical platform has been associated with bubbles emanating from the vitrector probe port during vitrectomy, according to a report.
Vitreoretinal surgeons who use the Constellation Vision System (Alcon) should be aware of bubble formation and be prepared to remove the bubbles to get a clear view of the retina, Sophie J. Bakri, MD, the corresponding author, said in an interview with Ocular Surgery News.
“The bubbles upset the surgeon’s routine. We spend a lot of time removing bubbles,” Bakri said.
Sophie J. Bakri
The bubbles underscore how frequently new technologies have problems, Bakri said.
“Whenever there are transitions to a new system, there are going to be issues and there’s going to be anxiety. I think that people just have to be prepared, evacuate the bubbles as safely as possible and get on with the surgery,” she said.
The report was published in Ophthalmic Surgery, Lasers & Imaging.
Early recall, later problem
In July 2010, the U.S. Food and Drug Administration initiated a recall of the Constellation Vision System based on reports of software and hardware issues related to unexpected loss of power, unintended system error messages, unresponsive touch screens, and system setting and infusion performance problems, with the possibility of eye injuries or blindness resulting from these issues, according to a recall notice posted on the FDA’s MedWatch page.
The problems that led to the recall were resolved, and Alcon launched the platform, Bakri said.
“We got the new version,” she said. “We were going to get the older version and then we heard from our colleagues about problems with shutdowns and the recall, and we held off. [The problems] were fixed, and we ordered the Constellation.”
When tiny bubbles appeared with 20-, 23- and 25-gauge vitrectors, Bakri said she and colleagues reported the problem to the manufacturer. Company representatives confirmed that settings on the machine were correct but were unable to identify the cause of the bubbles, Bakri said.
“Our settings are all fine,” she said. “It might be an issue with the software. It could also be an issue with a small membranous valve that actually allows the tiny bubbles to come through the valve. That would make sense. That explains why there are very tiny bubbles.”
Presence of bubbles
The bubbles can stick to the corneal endothelium, IOL, crystalline lens or capsule, requiring extra surgical steps to remove them, Bakri said.
“If the patient is pseudophakic, then the bubbles may come into the anterior chamber,” Bakri said. “First of all, they can stick to the back of the IOL, and then we’ve got to try to get the bubbles off without damaging the posterior capsule. Sometimes they get through the zonules if the zonules are weak, and the bubbles go into the anterior chamber. So, then we have to make another incision into the anterior chamber and take the bubbles out.”
The bubbles can float into the corneal endothelium and stick there, Bakri said.
“You have to get them out without damaging the endothelium,” she said. “In phakic patients, it’s actually quite hard to remove bubbles because they stick to the posterior capsule of the crystalline lens. Trying to remove those can disrupt the capsule and cause cataract. They’re very difficult to remove.”
Extra surgical steps to remove the bubbles increase the risk of complications, Bakri said.
“Any extra things that you do in the eye always have a possibility of problems,” she said. “You need to go in there. You need to do the work, do a great job and just get out. Any extra little steps can always add problems. That’s true in any kind of surgery.”
Before the procedure, Bakri said she and colleagues make sure that there are no bubbles in the line leading to the vitrector. However, the bubbles still appear in the vitreous. – by Matt Hasson