PURPOSE: High cut-rate, dual action cutters like the BiBlade+® have significantly increased the rate at which vitreous can be removed. This study compares the flow rates, traction, pulsatile flow, and the sphere of influence of the 7,500 cpm Bausch & Lomb single action (SA) pneumatic vitrector to the 25,000 cpm Bausch & Lomb BiBlade+® pneumatic vitrector.

METHODS: Porcine vitreous flow characterization was performed on the B&L SA and the Biblade+® pneumatic cutters. Vacuum levels for each cutter were chosen at flow-matched conditions. Excised porcine vitreous was placed into a cuvette and imaged at 10,000 fps. The vitreous endogenous biomarkers were tracked using particle image velocimetry techniques to produce vitreous traction distances and measure changes in the flow directionality near the port to calculate pulsatile flow. The 90th percentile of the traction data was used to calculate sphere of influence, which is the furthest distance at which the cutter can affect and pull the vitreous per single cycle. The pneumatic cutters were operated at their maximum cut rate; 7,500 CPM for the SA, and 25,000 CPM for the dual action.

RESULTS: Flow-matched conditions of 0.75 g/min were used with vacuum levels of 232 mmHg for the SA and 136 mmHg for the dual action cutter. These conditions showed the dual action cutter vitreous inflow was more consistent compared to the SA cutter with a 45.7% reduction in traction, 56.3% lower pulsatile motion, and 55.9% reduction in sphere of influence (all significant with p<0.05).>

CONCLUSIONS: The dual action BiBlade+® pneumatic vitrector generated less traction, exhibited less pulsatile flow, and had a smaller sphere of influence during vitreous removal at the same flow rate as compared to single action cutters. These results suggest that the BiBlade+®'s better flow stability, more localized action, and better predictability, may be advantageous in reducing adverse events during vitrectomies.