Eyeworld

FALL 2026 | EYEWORLD | 45 C Relevant disclosures Mai: None Patterson: Bausch + Lomb Weng: Alcon, BVI Medical, DORC/Zeiss Contact Mai: anthonymai.md@gmail.com Patterson: michaelp@ecotn.com Weng: christina.weng@bcm.edu To evaluate whether a combination ma- chine would be a cost-effective purchase for a facility, Dr. Weng said to consider factors like case volume, case mix, surgeon workflow, and reimbursement landscape. "Consider how many combined cases are typically done per year and whether having a combined machine impacts those numbers or shifts referral patterns. While purchasing a combined machine is often less costly than purchasing two separate towers, where on the lifecycle a facility's current equipment is at may also play a role in decision-making," she said. "Finally, a cost analysis should be performed, taking into account that while Medicare typical- ly only reimburses 50% of the second procedure in a combined surgery, there are also savings in expenditures in terms of time, equipment, overhead, etc. It is also important to factor in inventory management, space requirements, and cost of disposables, which are unique to each surgical center." am dealing with vitreous.' That's me included. If I bought a new one, I'd probably try to get a combined one," he said, adding, "but I don't want to buy a new one unless I have to." Dr. Weng reiterated that older combination systems would often excel in one platform and not both. She finds, however, that the newer generation combo platforms may exceed the performance of standalone systems. "Having a machine that 'does it all' is especially advantageous for complex posterior segment cases, which often require concurrent cataract extraction or anterior segment work. The optimization of phacoemulsification and fluidics facilitates a more effective and efficient cataract surgery, which may lessen the risk of posterior capsule compromise and corneal edema. Additionally, if a cataract surgeon is involved, the retina surgeon will be able to immediately follow without having to set up another machine," she said, reiterating some of her prior points. Pros of next-generation phacovitrectomy platforms Dr. Weng said recent technological develop- ments in the leading next-generation phaco- vitrectomy platforms target three areas that are important to surgeons: 1) patient safety, 2) surgical effectiveness, and 3) operational efficiency. Here's how Dr. Weng described the following systems, in her own words: The UNITY VCS integrates Intelligent Fluidics, which facilitate better stability of mobile retinal tissue and 4D phaco technology; that helps main- tain physiologic IOP and reduces post-occlusion surge volumes. Its vitrector also introduces a faster cut rate of 30,000 cuts per minute, which reduces tractional forces. Novel instrumentation including stiffer 27-gauge accessories and a TetraSpot laser probe have also been concurrently launched. BVI Medical introduced its new platform, Virtuoso, last fall (pending regulatory approval at time of writing). This dual-function machine acts as a fluidics equalizer in cataract surgery, actively maintaining the target IOP. The vitrectomy setting fuses the control of a flow pump with the efficiency of a pres- sure pump, which helps prevent eye collapse while maintaining aspiration efficiency when in liquid. It also minimizes footprint by integrating the air com- pressor in the console and offering a shroud-free, laser-integrated foot pedal. The EVA NEXUS (DORC/Zeiss) incorporates flow- based fluidics in their SMART IOP system to balance irrigation and aspiration; practically, this results in more precision with vitrectomy and better anterior chamber stability with cataract surgery. One recent study that included phacovitrectomy surgeries done with the EVA NEXUS reported fewer intraoperative adverse events compared to histor- ical rates. 1 The Stellaris Elite (Bausch + Lomb) offers an Adaptive Fluidics system that optimizes IOP sta- bility during phacoemulsification. For vitrectomy, there are a variety of cutting options including traditional pneumatic blade vitrectors as well as its unique hypersonic vitrectomy system, which removes vitreous through tissue liquefaction. The wireless pedal integrates multiple functionalities including laser control. Reference 1. Stalmans P. Clinical trial to test the safety of the EVA Nexus surgical platform. Int J Retina Vitreous. 2024;10:45.

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