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Clinical Experience With the PUREPOINT Laser

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The embedded PUREPOINT 532 nm photocoagulator on the CONSTELLATION Vision System (Alcon Laboratories, Inc., Fort Worth, TX; Figure 1) is both complex in design and function yet extremely simple to use. The features on the laser increase overall surgeon control and precision and help to streamline surgical procedures for better efficiency and safety.

In my opinion, there are three critical benefits to PUREPOINT laser: increased surgeon control, decreased reliance on surgical staff, and enhanced delivery of quality care. In this article, I describe the key features on the PUREPOINT and how each improves my surgical procedure.

SYSTEM FEATURES
ENGAUGE Radio Frequency Identification (RFID) allows the laser to automatically recognize the device that is being plugged in and immediately populate the parameters accordingly.

With the footpedal on the PUREPOINT laser, the surgeon can switch the laser from standby to ready and power delivery can be altered up and down on the laser. Additionally, voice confirmation occurs when parameters are changed.

There are two ports on the PUREPOINT laser, which enable the endolaser and the laser indirect ophthalmoscope (LIO) to be simultaneously plugged in. The switch from endolaser to LIO, and vice versa, can be performed on the same platform without any alterations required from staff.

The ports also have color ring indicator lights that act as insertion accuracy tools for the person who is plugging in the laser delivery devices.

THE ENDOLASER PROBE
The endolaser probe that I use with the PUREPOINT laser system is the curved Flexible Tip Laser Probe (FLP; Figure 2). The FLP has a 33-gauge nitinol tip with a 40°-bend angle and a 6-mm bend radius. The overall length of the probe is approximately 26 mm and the construction is a rigid, thick-walled, tapered cannula.

The nitinol tip on the FLP can be straightened to go through the trocar and reassumes its curvature once the probe has entered the eye. The small-tip diameter and tapered cannula allows for easier insertion into the trocar and, once in the eye, the flexible curved tip allows for greater access to the periphery (Figure 3). The configuration of the FLP minimizes retina touch and contact with the crystalline lens, reducing the risk of secondary cataract.

The laser probe that I used previously was the Stepped Angle Probe (Iridex Corporation, Mountain View, CA). The Stepped Angle Probe has a larger entry diameter and a fixed angle that is not continuously curved. The angulation of this probe increases the likelihood that it will have contact with the lens. I have also used a directional laser probe which has a separate fiber that extends from the end. Although this is a more difficult probe to use, it remains an excellent tool when used correctly.

My idea of superior surgical instrument design, however, is that which takes into account all users. In my opinion, the best design results in instrumentation that, if put into the hands of a retina fellow, would enhance his or her ability to achieve the surgical goal and increase the overall safety profile. This next generation of Alcon laser probes represent intelligent design and a significant step forward in vitreoretinal surgery.

PLATFORM STABILITY
I have been most impressed with the stability of Alcon’s laser platform throughout the evolution of the technology. The stability of the new-generation PUREPOINT photocoagulator is further improved to significantly increase the quality of the laser burn that it delivers. The PUREPOINT laser has a high-energy capacity, multiple mode settings, and micropulse and continuous laser modes. In summary, the PUREPOINT laser delivers reproducible, targeted, and precise laser energy.

Timothy G. Murray, MD, MBA, FACS, is Professor of Ophthalmology and Radiation Oncology at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine. Dr. Murray is a consultant for Alcon Laboratories, Inc. He can be reached at tmurray@med.miami.edu.

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