OSLI Retina

March 2020

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196 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ I N S T R U M E N T S / D E V I C E S / T E C H N O L O G Y ■ A Microsurgical Vacuum Pick for Membrane Peeling Without Forceps During Vitreoretinal Surgery Carl C. Awh, MD; Eric J. Bass, BSME BACKGROUND AND OBJECTIVE: To describe a new device and method for peeling membranes without forceps during vitreoretinal surgery. MATERIALS AND METHODS: A novel micro-vacuum- pick (MVP) was used to peel internal limiting mem- brane (ILM) and/or epiretinal membrane (ERM) in 24 consecutive pars plana vitrectomy procedures. The MVP was used to create an edge in the mem- brane, strip the membrane from the retinal surface, and evacuate the membrane from the eye through the lumen of the device using active aspiration. RESULTS: The MVP was the sole device used to peel and remove ILM and/or ERM in each case. No surgi- cal complication occurred during any case. The MVP was used to perform the fluid-air exchange in all cas- es in which a fluid-air exchange was performed. CONCLUSIONS: The MVP introduces a new method of peeling ILM and ERM without forceps. The MVP device and method eliminate the need for a sepa- rate device to create an edge in the ILM or ERM, reduce or eliminate instrument exchanges during membrane peeling, and eliminate the need for a separate extrusion cannula for fluid-air exchange. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:196-199.] INTRODUCTION Peeling internal limiting membrane (ILM) and/ or epiretinal membrane (ERM) from the retinal sur- face ("membrane peeling") is the primary goal of surgery to address a variety of vitreoretinal pathol- ogies and is one of the more technically challenging ophthalmic surgical techniques. Membrane peeling is a critical component of surgery to address macu- lar hole (MH), ERM, macular edema, diabetic reti- nopathy, and proliferative vitreoretinopathy. Although there is considerable variation in tech- nique, membrane peeling is typically performed using vitreoretinal forceps, with four steps com- mon to most membrane-peeling procedures, listed as follows: 1) Identify or create a membrane edge or flap; 2) Secure the membrane flap with forceps; 3) Peel membrane from the retina with forceps; and 4) Remove forceps from the eye while grasping and removing the peeled membrane. Membranes are relatively weak structures and may tear as they are peeled. Therefore, membrane peeling often involves repeating one or more of the four steps. For example, a surgeon may peel a por- tion of ILM, remove the forceps and ILM from the eye, wipe the ILM from the forceps, reinsert the forceps (typically requiring adjustments in viewing system illumination and focus), create and grasp a new ILM flap, and repeat steps as necessary. Instru- ment exchanges are time-consuming and may in- crease the risk of retinal breaks due to vitreoretinal traction as forceps push through peripheral vitre- ous. Valved cannulas can strip pieces of membrane From Tennessee Retina, PC, Nashville, Tennessee (CCA); and Katalyst Surgical, Chesterfield, Missouri (EJB). Originally submitted October 20, 2019. Revision received October 20, 2019. Accepted for publication December 26, 2019. Presented at the 2019 EURETINA conference in Paris, France, in September 2019. Dr. Awh is a consultant for, has stock in, and has intellectual property with Katalyst Surgical. Mr. Bass is an employee of and has stock in Katalyst Surgical. Address correspondence to Carl C. Awh, MD, Tennessee Retina, PC, 345 23rd Avenue North, Suite 350, Nashville, TN 37205; email: carlawh@gmail.com. doi: 10.3928/23258160-20200228-09

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