Since the Stellaris was introduced in 2007, those of us who perform phaco surgery have benefited from the optimized phaco power, separate control of ultrasound and vacuum, excellent control of fluidics, the dual linear foot pedal, and of course the 1.8 mm microincision. With microincision cataract surgery (MICS), we can provide our patients with a safer self-sealing incision that results in less trauma to the eye during surgery and faster healing postoperatively. For some time, Bausch + Lomb has been developing the new vitreoretinal surgery component for the Stellaris, and the result is the Stellaris PC, PC stands for Procedural Choice. The Stellaris PC is by itself an elegantly engineered system with multiple features to improve our posterior segment surgeries, including but not limited to an ultra-high speed pneumatic vitreous cutter, advanced illumination with three color filters, and an easy-to-use interface.
Because I perform many combined anterior and posterior segment surgeries in my practice, what I appreciate most about the Stellaris PC is that the features that I enjoy for phaco surgery actually enhance my ability to perform vitrectomy.
Features on the Stellaris PC
It is true that many patients who require cataract surgery have retinal comorbidities such as epiretinal membranes, macular holes, diabetic retinopathy, and retinal detachment.
CLICK TO WATCH DR. BELLUCCI PERFORM 23-GAUGE EPIRETINAL MEMBRANE REMOVAL.
These problems can be solved by combining MICS and posterior transconjunctival sutureless vitrectomy (TSV). Because MICS does not impair the cornea, I have a better visualization of the retina for the posterior portion of the surgery. Additionally, the 1.8 mm MICS incision does not leak during vitrectomy and the intraocular lens stays well positioned after posterior surgery is complete.
CLICK TO WATCH DR. BELLUCCI PEEL DIABETIC MEMBRANE.
The redesigned Venturi pump system offers excellent fluidics control for both MICS and TSV and I am able to use lower pressure on infusion. This is particularly important during cataract removal after I have inserted the trocar for the vitrectomy procedure, because the lens diaphragm will not be pushed backward.
CLICK TO WATCH DR. BELLUCCI PERFORM MICS PORTION OF COMBINED PROCEDURE.
The combined procedure disposable packs allow an easy transition from anterior to posterior segment surgery.
The 5000 cpm on the cutter of the Stellaris PC reduces the traction on the retina, and because the port has been designed to be closer to the tip of the needle, I can safely bring my cutter closer to detached retina than was allowable with the Millennium Microsurgical System (Bausch + Lomb). In addition, the high-speed vitreous cutting will fragment the vitreous into very small pieces, thus giving the aspirated fluid the characters of Newtonian fluids. Ergonomically speaking, the handpiece has been designed with a longer handle, increasing surgeon comfort.
The Stellaris PC provides both xenon and mercury lamp types and the three available color filters improve visualization of vitreous for removal. The dual independent lamps have been designed to eliminate phototoxic wavelengths.
The new 23- and 25-gauge disposables allow easier insertion of the trocars and smoother surgery. The new disposable forceps are designed to grasp the membranes with strength and precision and pull them with the proper force.
Figure 1. A one-step solid trocar is inserted at the beginning of a combined case.
Figure 2. Phaco through 1.8-mm incision on a brunescent cataract.
Case Examples
In the first combined case that I performed with the Stellaris PC (Figure 1), the patient had a dense cataract (Figure 2) and an epiretinal membrane (ERM). The Venturi pump was particularly helpful for this scenario because the fluidics kept the chamber stable. The phaco procedure was smooth and I only had to raise the bottle to 60 cm and use 10% maximum ultrasound power. After implanting the IOL through the 1.8-mm incision, I made an easy transition to the posterior segment. I stained the membrane with triamcinolone acetonide and used an amber color filter to minimize the white color of the drug and to see the central vitreous on removal (Figure 3).
Figure 3. The amber filter is used to reduce the glare from triamcinolone acetonide.
I removed the diabetic membrane with the new Bausch + Lomb 23-gauge disposable forceps (Figure 4).
A
B
Figure 4. The ERM is lifted with 23-gauge disposable forceps(A) and gently removed (B).
and for the internal limiting membrane (ILM), I used Brilliant Peel (Fluoron, Ulm, Germany); with this dye and the light source on the Stellaris PC, the ILM can be safely and easily removed using Tano forceps. After ILM removal, I removed the remaining central membrane material.
CLICK TO WATCH 25-GAUGE COMBINED DENSE CATARACT AND ERM REMOVAL.
To perform every type of sutureless vitreoretinal surgery we use the 23-gauge set of instruments, which make posterior vitreous detachment easy. With 23-gauge, I find it easy to remove the ERM and ILM. Using 5000 cpm and the excellent fluidics control on the Stellaris PC, I can approach the retina for careful vitreous removal. The viscous fluid pump allows us to use silicone oil internal tamponade for macular hole (Figure 5). The same 23-gauge approach is preferred for retinal detachments, when it is very important to match fluidics and cutting for close retinal work.
Figure 5. Silicone oil is put into the posterior chamber as tamponade for a macular hole case.
Summary
In my opinion, the Stellaris PC is the first truly complete combined surgical platform and has become my most effective partner in surgery. The machine has features that make the transition from the anterior segment to the posterior segment extraordinarily smooth in terms of safety and efficacy, so surgeons no longer need two systems to perform both surgeries at the highest level. The posterior segment surgeon will find in the Stellaris PC the best partner for advanced vitreoretinal surgery, without the need for a second machine for advanced cataract surgery.
Roberto Bellucci, MD, is the Head of the Ophthalmic Unit at the University Hospital, in Verona, Italy. He reports that he is a consultant to Bausch + Lomb. Dr. Bellucci may be reached at roberto.bellucci@ospedaleuniverona.it.
