instrument insider
BD Ophthalmic Systems Vitrectomy Unit
Reviewed by Robert Josephberg, M.D.

The compact, portable Visitrec vitrectomy unit, manufactured by BD Ophthalmic Systems, has always been a powerful and practical tool for vitrectomy-related procedures. Now, BD has added a new 23-gauge guillotine cutter to the options available with this unit.

This is significant because the new cutter can fit through a 0.6-mm incision that doesn't require sutures, allowing many vitrectomy-related procedures to be performed in your office. (As you know, most surgeons use 20-gauge instrumentation, necessitating larger incisions that require sutures. This means procedures must be performed in an operating room using a full set-up, at considerable expense. Even the 25-gauge instruments currently being introduced into the market -- which also require a 23-gauge incision -- still need a full operating room setup and staff.)

The new Visitrec 23-gauge guillotine cutter makes it possible to perform sutureless vitrectomy in your office.

The guillotine cutter comes sterile and ready to use. In addition, it has a microvitreoretinal (MVR) blade built into the tip, which lets you make a transconjunctival and transcleral incision in a single motion, without a secondary alignment instrument. The incision made with the new cutter provides enough room for a quick diagnostic sample; you can easily obtain an adequate amount of specimen or perform a mini core vitrectomy, making the unit very cost-effective.

The safety of office-based surgery using the Visitrec unit was confirmed by a study published in Retina (Hilton, et al., December, 2002 issue). More than 225 cases were completed using an office-based sutureless transconjunctival pars plana vitrectomy technique; fewer than 6% of the patients experienced any complications.

The vitrectomy unit itself has numerous advantages. The small size makes it portable, and because it's battery powered it sets up in seconds, eliminating time-consuming delays and significantly reducing costs. (Plus, faster diagnosis and treatment usually lead to better visual outcomes, especially in cases of potential endophthalmitis.) You can adjust cutting speed from 60 to 400 cuts per minute, and the handpiece is automated, featuring a linear-activated cutter. Several other guillotine size options are also available. (The unit even monitors the battery so you don't run out of power unexpectedly.)

Being able to perform this kind of surgery in the office should have a significant positive impact on any practice that provides this kind of service. (Note: Another recent development also bodes well for surgeons who perform this type of surgery: A new CPT code covers partial vitrectomy, so surgeons can now receive third-party reimbursement.)

Dr. Josephberg is assistant clinical professor and chief of retina at New York Medical College of Westchester Medical Center in Valhalla, N.Y. He has a financial interest in this product.