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ELIMINATION OF INFUSION BUBBLES AND UNCONTROLLED REFLUX IN THE ALCON CONSTELLATION VITRECTOMY VISION SYSTEM

Russell, Stephen R. MD*,†; Sohn, Elliott H. MD*,†; Boldt, H. Culver MD*,†; Folk, James C. MD*,†; Tarantola, Ryan M. MD; Kay, Christine N. MD*,§; Mahajan, Vinit B. MD, PhD*,†,¶

doi: 10.1097/IAE.0b013e31826c20c6
Original Study

Purpose: To identify the sources and management of 2 problems associated with the Alcon Constellation Vitrectomy (Alcon Laboratories, Inc) System: 1) infusion bubbles and 2) uncontrolled reflux.

Methods: Surgical and analytical videos were evaluated to identify the source of intraoperative bubbles, which localized to the duckbill valve (DV). Intraoperatively, the authors modified the infusion tubing and its control by removing the DV. The DV was repurposed as a one-way valve to block reflux originating from the vitrectomy console.

Results: Twenty consecutive 23-gauge vitrectomies in 20 eyes of 20 subjects from 2 surgeons (S.R.R. and E.H.S.) were reviewed. Infusion bubbles at the DV developed with each transitory tubing pressure drop upon opening of the infusion clamp. Removal of the DV from the infusion line eliminated infusion bubbles in 20 consecutive 23-gauge cases. Adding a one-way valve, which was fashioned from the DV, to the aspiration tubing, resulted in elimination of infusion bubbles and console-originated reflux in 20 eyes. Placement of the DV to block reflux eliminated both uncontrolled and purposeful console-originated reflux.

Conclusion: Intraoperative modification of Constellation tubing may eliminate two potentially harmful problems until manufacturer correction is instituted. Because the authors’ modified connections represent off-label connectivity, the manufacturer cannot contact potentially affected surgeons or suggest temporary alternative connectivity improvements.

Intraoperative modification of Constellation tubing may eliminate two potentially harmful problems until manufacturer correction is instituted. Because the authors’ modified connections represent off-label connectivity, the manufacturer cannot contact potentially affected surgeons or suggest temporary alternative connectivity improvements.

*Department of Ophthalmology and Visual Sciences,

Carver Center for Macular Degeneration, Institute of Visual Research, Carver College of Medicine, University of Iowa, Iowa City, Iowa;

Department of Ophthalmology, Saint Louis University, St Louis, Missouri;

§Department of Ophthalmology, University of Florida, Gainesville, Florida; and

Omics Laboratory, University of Iowa, Iowa City, Iowa.

Reprint requests: Stephen R. Russell, MD, Department of Ophthalmology, Carver College of Medicine, University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242; e-mail: stephen-russell@uiowa.edu

Supported by the Donald H. Beisner, MD, and Judith Gardner Beisner Chair for Vitreoretinal Diseases and Surgery (J.C.F.), The Marion and Frederick Fuerste Chair in Ophthalmology (H.C.B.), The Dina J. Schrage Professorship for Macular Degeneration (S.R.R.) and an unrestricted grant from Research to Prevent Blindness, Inc, New York, NY, to the Department of Ophthalmology and Visual Sciences, Carver School of Medicine, the University of Iowa.

The authors declare no conflict of interest.

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© The Ophthalmic Communications Society, Inc.