Safety and Efficacy of Hypersonic Vitrectomy for Retinal Reattachment Surgery in Proliferative Vitreoretinopathies.

Introduction: To investigate the safety and efficacy of the Vitesse hypersonic vitrectomy device for retinal reattachment surgery in proliferative vitreoretinopathy (PVR) or proliferative diabetic vitreoretinopathy (PDVR) cases. The Vitesse device utilizes hypersonic technology to liquefy instead of cutting the vitreous, providing an alternative to the traditional pneumatic guillotine cutter. Material and Methods: A prospective, one-armed, non-comparative, open-label study was performed. Sixteen patients with a diagnosis of PVR or PDVR that required retinal reattachment surgery were included. Severity of disease was classified using the Retina Society 1983 classification and Kroll Classification from 2007. Patient data was collected preoperatively, 2 days postoperatively, 1 month postoperatively, and 3 months postoperatively. Efficacy of hypersonic vitrectomy was evaluated, both subjectively using a questionnaire and objectively by means of Supplementary Video documentation, device settings, and data collection of the patients' medical history. Results: In all 16 cases, retinal reattachment surgery could be performed with Vitesse without conversion to a guillotine cutter. The vitreous could be separated from the detached retina completely with no iatrogenic tissue damage. Vitreous traction was documented in one case. In 6 cases, shaving of the vitreous base was performed after early fluid-air exchange with hypersonic vitrectomy without any complications. No adverse events suspected to be related to hypersonic vitrectomy were documented in the follow-up visits. Conclusion: The Vitesse has potential advantages including reduced vacuum volumes with limited amount of turbulence and avoidance vitreoretinal traction. Liquefaction directly in front of the probe entrance allows for continuous unrestricted fluid flow. These factors of hypersonic technology allow to carry out retinal reattachment surgery in PVR or PDVR cases successfully.

[Pars plana vitrectomy-from suction cutting systems to ultrasound technology : Vitesse-a new form of vitrectomy based on ultrasound technology]. / Pars-plana-Vitrektomie ­ von Saug-Schneide-Systemen bis hin zur Ultraschalltechnik : Vitesse ­ eine neuartige Form der Vitrektomie mittels einer Ultraschalltechnik.

In the 1970s a cutting device into which an infusion and an aspiration channels were integrated, the so-called vitreous infusion suction cutter (V.I.S.C), was used for the first time for the removal of the vitreous body. These cutting systems have continued to constantly evolve since then; however, sonic energy remained reserved for anterior segment surgery for a long time. In 2020, this form of energy could also be used for the posterior segment in form of Vitesse™. In this liquification technique, ultrasonic energy is transferred to a single, large inner lumen design that mechanically vibrates the needle's port. These high-speed vibrations shear the vitreous body at the port edges before it enters the needle. This mechanism reduces traction to a minimal level and enables faster aspiration at lower vacuum levels compared to conventional cutters. These advantages can promote a safer and more efficient vitreoretinal surgery.