PC = Procedural Choice

The Stellaris PC enables state-of-the-art sutureless vitrectomy and microincision cataract surgery

PC = Procedural Choice

The Stellaris PC enables state-of-the-art sutureless vitrectomy and microincision cataract surgery.

By David R. Chow, MD, FRCSC

Since the 1960s, when the late Robert Machemer, MD, began experimenting with a hypodermic needle and a drill bit attached to a battery-powered micromotor, vitreoretinal surgery has marched steadily down the path of innovation.

Dr. Machemer tested his apparatus by extracting yolks and whites from eggs, and his work led to the development of the first clinically applied vitrector. The VISC—vetreous infusion suction cutter—had an inner lumen for suction and an outer lumen for infusion. In the very first case, it was used to treat a diabetic vitreous hemorrhage. Because the VISC lacked illumination, the first cases were performed at an operating microscope with the aid of a slit lamp. The second-generation VISC, introduced in 1976, included an illumination sleeve.

Around the same time, Gholam Peyman, MD, was designing vitrectomy probes. He is credited with developing the first guillotine cutter with coaxial infusion. Also in the 1970s, Nicholas Douvas, MD, introduced his roto-extractor, which was used predominantly for lensectomies but also for vitrectomies, and Conor O'Malley, MD, pioneered the first three-port vitrectomy setup.

In the years that followed, the Storz Instrument Company became involved in the development of vitreoretinal technology and, often in conjunction with Bausch + Lomb, brought a long list of innovative instruments to the field. The Daisy (Storz), for example, was a thoroughly integrated unit that debuted in 1986. Its functions included irrigation/aspiration, anterior and posterior vitrectomy, bipolar coagulation, automated scissors, illumination, air exchange and phacoemulsification and fragmentation. Surgeons could select the vitrectomy mode to enable foot-pedal control of the vacuum setting. The disposable vitrectomy cutter was an improved version of the Microvit, and the cutting rate was adjustable from 30 to 600 cpm. Product literature at the time also highlighted the “rugged plastic Data Key,” which could be programmed with the surgeon's name, preferred settings in every mode and the screen display language.

In 1990, Storz introduced the Premiere, which retained all elements of the Daisy but elevated their performance to the gold standard. Innovative electronics, pneumatics and software were designed to guarantee superior performance and reliability and provide options for both beginning and experienced surgeons. The Microseal handpiece system enhanced safety by reducing turbulence and fluid loss, thereby protecting the endothelium. The Venturi pump was at the heart of the Premiere aspiration system. With no moving parts, it provided the most advanced and precise way of generating microsurgical aspiration with a highly responsive foot pedal control.

By 1997, Bausch + Lomb had introduced the now-familiar Storz Millennium Microsurgical System, the first truly integrated system that fully supported both anterior and posterior surgery. The Millennium features a unique pump that emulates both Venturi and peristaltic pumps. It also features the very important advance of dual linear control on the foot pedal. This allows the surgeon to directly control the fluidics and ultrasonic power or vitrectomy cut rates simultaneously as well as immediately switch control modes and adjust parameters. The ability to directly and easily change options enhances the surgeon's performance and concentration while freeing up the rest of the operating room staff. The Millennium is also a modular system, so practices can easily upgrade as future improvements become available.

Today, Bausch + Lomb has followed the Millennium with its new, state-of-the-art, combined vitrectomy and phaco emulsification system, the Stellaris PC (Procedural Choice) Vision Enhancement System. The Stellaris PC is the only vitreoretinal surgical system that comes with a dual light source and surgeon-selected color filters that enhance visualization under various surgical conditions. It allows surgeons to perform both cataract and retinal surgeries through the smallest possible incisions. It is equipped for Bausch + Lomb's 1.8-mm microincision cataract surgery and retinal surgery with 25-gauge, 23-gauge and 20-gauge instrumentation. In addition, its light-weight, ultra-high-speed vitrectomy probes can be used to perform conventional or transconjunctival vitrectomy.

In the following articles, several surgeons provide more details about the Stellaris PC and the advantages it offers to vitreoretinal surgeons and their patients.

■ Carl Awh, MD, describes his first cases with the new system, including its functionality and versatility.
■ Tarek Hassan, MD, elaborates on the system's advanced fluidics and vitreous cutting capabilities.
■ Philip Ferrone, MD, explains the redesigned 23-gauge entry site trocar system that complements the Stellaris PC.
■ Suber Huang, MD, explains how the versatile illumination employed by the Stellaris PC enhances safety and visualization.

Dr. Chow is an assistant professor at the University of Toronto.