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To the Editor:
We read with great interest the article by Eckardt entitled “SQUEEZER—A NEW DEVICE FOR VITREORETINAL SURGERY.”1 In this brief article, the author described a novel disposable device to inject perfluorocarbon liquid or dye into the vitreous cavity. The author illustrated several advantages of the Squeezer over the syringe. First, the Squeezer is held in a more comfortable and stable way allowing the surgeon to place the needle close to the retina. In addition, each squeeze of the device releases a fixed quantity of dye or perfluorocarbon liquid (around 1 cc), permitting a more reproducible and dosed injection. Although all these points suggested by Eckardt are doubtless great step-forwards, we believe they missed one of the major advantages of the device, that is, its safety role in the chromovitrectomy field. Indeed, the dye jet generated by the squeeze occurs in a gentle and slow fashion, which comes particularly useful in macular surgery, especially when dealing with a macular hole or with a thin myopic retina. The dye migration into the subretinal space is a recognized complication of chromovitrectomy exerting a toxic effect toward the retinal tissue.2 The violent, axial jet coming from the tip of the syringe has been advocated as a leading causative factor.3 Several strategies have been proposed to limit this phenomenon. Many substances may be placed as a shield over the fovea including sodium hyaluronate, perfluorocarbon liquid, and autologous blood.4 Toygar et al3 proposed a dual-bore cannula (SideFlō; MedOne Surgical, Sarasota, FL) with a terminal port placed on the side and 1-mm proximal to the tip eliminating the axial jet and decreasing the impingement pressure. In a previous article, we reported a novel dye injection technique using the “Drip Dropper” device (Katalyst Surgical LLC, Chesterfield, MO).5 This device consists of a rubber bulb reservoir, which is squeezed to generate the flow, a stainless steel 25-/23-G needle ending in some models with a silicon-coated diamond tip, and a valve, which ensure a gentle dye flow. The Drip Dropper shares some advantages with the Squeezer including the more comfortable and stable handling and the delicate dye injection. However, the latter device has some peculiar advantages, including the dosed dye injection, the valve preventing fluid reflux, and the possibility to recharge it easily and rapidly without extraction from the vitreous cavity.
For all the above considerations, we are convinced that these devices will represent a big step forward toward a safer chromovitrectomy.
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