Cutting without a blade: a clinical review of hypersonic vitrectomy

This review synthesises clinical evidence on hypersonic vitrectomy (HV), examining the gap between its theoretical advantages and observed performance. Originally proposed to reduce vitreoretinal traction and deliver smoother fluidics, HV has achieved successful vitreous removal in human studies, with surgeons reporting favourable qualitative handling. However, comparative trials have yielded mixed results for surgical efficiency versus contemporary pneumatic guillotine vitrectors. Prospective series also describe operational challenges, including intraoperative conversion to guillotine vitrectors in up to 30% of cases, often attributed to inconsistent vitreous liquefaction. Distinct safety considerations have been reported, most notably sclerotomy-site thermal injury and silicone oil emulsification. These findings underscore the difficulty of surpassing a rapidly evolving standard of care. Defining HV's role in vitreoretinal surgery will require continued device refinements and adequately powered, multicentre comparative studies to determine where HV offers clear, reproducible benefits.