Lowering Pressure During Vitrectomy May Improve Surgical Safety
New advancements in vitrectomy surgery are allowing surgeons to perform procedures at significantly lower intraocular pressures (IOP), potentially leading to safer outcomes for patients. A recent presentation at the Retina 2026 meeting in Waikoloa, Hawaii, highlighted the benefits of Posterior Adaptive Fluidics (PAF), demonstrating a 62% reduction in mean infusion pressure during vitrectomy.
Vitrectomy, a complex surgical procedure to treat various retinal conditions, traditionally involves maintaining a certain level of pressure inside the eye to prevent bleeding or collapse during the operation. However, this higher pressure can also pose risks to the patient. “Most vitrectomy surgery involves an infusion pressure through our infusion cannula that different doctors set at different levels,” explained Jorge Calzada, MD, in a presentation covered by Healio. “I’ve seen doctors as high as 45 mm Hg, 35 mm Hg and 30 mm Hg.”
The PAF system, integrated with the Stellaris Elite platform from Bausch + Lomb, addresses this challenge by dynamically adjusting infusion pressure based on the surgeon’s actions. Instead of maintaining a constant high pressure throughout the surgery, PAF allows for a lower basal infusion pressure that increases proportionally as the surgeon applies aspiration with the foot pedal. This adaptive approach aims to more closely mimic the eye’s natural pressure levels during the procedure.
In a study conducted by Dr. Calzada and colleagues, the PAF system achieved an IOP of 4.2 mm Hg at 200 mm Hg vacuum. This represents a substantial decrease compared to traditional vitrectomy techniques. The reduction in mean infusion pressure was reported as 62% when using PAF compared to procedures not utilizing the system.
“What we are demonstrating is, first of all, can it be done, are there any complications or any problems, and do we really have a lower intraocular pressure during surgery?” Dr. Calzada stated. “The answer is yes. The data demonstrate this, and I think Here’s a safer way to perform vitreoretinal surgery with pressures closer to physiologic levels.”
The development of Adaptive Fluidics, including the PAF system, represents a broader trend of technological advancements in the field of vitreoretinal surgery. Other platforms, such as Alcon’s Unity Vitreoretinal Cataract System and BVI’s Virtuoso DUAL, are also incorporating intelligent fluidics and IOP control to improve surgical efficiency and patient outcomes. DORC’s Eva Nexus also includes VTi pump fluidics and Smart IOP intelligence.
While the long-term implications of performing vitrectomy at lower IOPs are still being investigated, the initial findings suggest a promising step towards minimizing surgical risks. The ability to stabilize IOP during vitrectomy is particularly important for patients undergoing procedures for conditions like rhegmatogenous retinal detachment, where maintaining a stable surgical field is crucial for successful repair.
The use of Adaptive Fluidics is not without consideration. Surgeons must be properly trained in the use of these new systems to ensure optimal performance and avoid potential complications. Further research is ongoing to fully evaluate the benefits and limitations of this technology across a wider range of patients and surgical scenarios.
Dr. Calzada has disclosed research support from several pharmaceutical and medical device companies, including 4DMT, AbbVie, Adverum, Ambrx Biotherapeutics, AstraZeneca, Baptist Hospital Research Institute, Bausch + Lomb, Beyeonics, Character Bio, Daiichi Sankyo, EyePoint, Genentech, Ionis, Iovance Biotherapeutics, NGM Bio, Regeneron and Roche, and is a paid speaker for Apellis and Bausch + Lomb.
