Twenty-three-gauge hypersonic vitrectomy: real-world surgical evidence.

PURPOSE To evaluate safety, effectiveness and the best parameters setup of hypersonic vitrectomy (HV). METHODS Prospective, multicentric, interventional study on 50 eyes that had undergone HV due to various vitreoretinal diseases. We primarily assessed effectiveness of vitreous removal, intraoperative complications and surgical setup. Secondarily, we evaluated single-surgery anatomical success and postoperative best-corrected visual acuity (BCVA). RESULTS Intraoperative complications occurred in 5 eyes (10%), whereas, technical problems were detected in 23 eyes (46%) resulting in conversion to guillotine vitrectomy (GV) in 15 cases. The most common finding related to the technical problems was an inadequate vitreous liquefaction with formation of vitreous strands and consequent inadequate vitreous outflow, sometimes complicated by vitreous incarceration in the vitrectomy probe. The best settings were considered stroke of 60 μm and vacuum of 40 mmHg for both core and peripheral vitrectomy. At 3-month follow-up, primary anatomical success was achieved in 49 eyes (98%) and mean BCVA overall improved. CONCLUSION The availability of HV in the current surgical practice opens a new era in vitreoretinal surgery. Despite the potential advantages in terms of fluidics, the performance of HV system needs to be further optimized, mainly for the occurrence of inadequate vitreous liquefaction and vitreous strands formation.