Surgical Case Review

Sponsored by Oertli Instrumente AG, Switzerland

In this monograph, my colleagues have written about many of the proposed benefits of the Oertli OS4 platform. As the saying goes, however, a video is worth a thousand words. That is to say that while the advantages of the OS4 can be understood on a theoretical level by reading about the various settings and hardware and software offerings, they are best understood when they are demonstrated during surgery.

The following article contains several cases that I think help demonstrate the advantages my colleagues have highlighted so far. Because I feel that the differences with other platforms is most evident in difficult cases, I will present a series of complicated cases with a brief overview of why the use of the OS4 helped me perform a surgery that was safer for the patient and achieved a successful outcome.

Case No. 1: Surgery for a Traumatic Subluxated Cataract Using SPEEPMode and easyTip

In this case, I performed an anterior vitrectomy to remove prolapsed vitreous using SPEEPMode. A chamber maintainer was used and left in place after vitreous removal and before going after the lens, as there is often a need to repeat vitrectomy in these cases. However, the use of an easyPhaco tip avoids oscillating energy, and the anterior chamber remained very stable through the entire surgery. As a result, there was no need to repeat vitrectomy. An additional benefit of using the OS4 in this case is that I was able to perform a posterior capsulorhexis in the presence of a capsular tension ring using SPEEPMode without being concerned about inducing an iatrogenic tear.

Case No. 2: Core Vitrectomy in an Eye With Detached Retina

Here I demonstrate my typical settings for core vitrectomy in an eye being operated for a detached retina. Most surgeons will use a Venturi pump for such a case to minimize traction in the periphery. However, as demonstrated in the case when I briefly switch to the Venturi setting, the entire retina is under traction. When I switch to SPEEPMode, I am able to perform core vitrectomy without inducing tractional forces, thereby reducing the risk of equatorial breaks.

Case No. 3: Surgical Preferences for Peripheral Vitrectomy

When using SPEEPMode and the Continuous Flow-Cutter, it is possible to gently shave vitreous in the periphery without inducing traction. Peristaltic pumps are often used so that the operator can use lower cutting speeds. However, coupling the Continuous Flow-Cutter with SPEEPMode allows me to safely use much faster cut rates. If I use Venturi in the periphery, I hold the cutter opening away from the retina to be safe. With SPEEPMode, it is possible to hold the opening to face the retina.

My preferred settings on the OS4 platform for 23G vitrectomy are as follows:

• Core vitreous: with SPEEPMode Flow 20 ml, Vacuum 300 mmHg, Cut Rate 3,000
• Peripheral shaving: with SPEEPMode Flow 5 ml, Vacuum 250 mmHg, Cut Rate: 4,000

Case No. 4: Correct Positioning with the 25G Chandelier

In this case, I demonstrate the correct positioning for using a chandelier in bimanual cases. The new Oertli 25G Chandelier provides perfectly bright and stable 360° illumination.

Case No. 5: Repositioning the Light Pipe To Gain Better Visualization

Repositioning of the chandelier from one trocar to the opposite trocar allows best visualization for shaving at the 12 o’clock position.

Case No. 6: Macular Hole Technique With Inverted Flap

In this case involving a macular hole, I am using a novel forceps, the Membrane FEELceps (Figure 1). This instrument has advantages:

• Strong holding capability at the tip
• No sticking of tissue on the tip, making it the perfect tool to perform an “inverted flap technique” for macular holes

Membrane FEELceps in 23 Gauge

Membrane FEELceps in 25 Gauge

Available with symmetrical tip.

Available with asymmetrical tip.

Figure 1. Membrane FEELceps in 23 Gauge, Membrane FEELceps in 25 Gauge, available with symmetrical tip, and available with asymmetrical tip.

Case No. 7: Technique for Oil Injection

The Oertli trocar system is another highlight of the platform: the knife design is very smart. The incisions are perfectly tight; it is almost impossible to find the wound after removal. Additionally, I really like the fact that silicon oil can be filled with a 20G cannula place in the trocar head at maximum speed, because the complete lumen of the trocar is used to fill the oil.