PARS PLANA VITRECTOMY IN RESOURCE LIMITED COUNTRIES

Introduction

Retina Detachment Surgery and other surgeries of the vitreous body require an invasive procedure known as Pars Plana Vitrectomy. This involves accessing the vitreous body in the eye through small openings on the Sclera and inserting a Vitrectomy Probe, Light Source, Infusion Line and some other instruments as required by the procedure in question. For this surgery to be performed one would need an Operating Microscope with special adaptor for lenses that will allow for intra-ocular viewing, A Vitrectomy Machine that will have several components integrated and a Laser Machine. Most Ophthalmology Centres will have an operating microscope for which posterior segment viewing adaptors can be attached or contact vitrectomy lenses. The problem tends to be the expensive Vitrectomy / Phacoemulsification Machine that will include a Light Source, Laser Aperture, Air Injector, Oil Injector, Oil Extractor and Diathermy. These Combo machines retail in excess of $ 50,000 and most require consumables for each procedure. 

Question

Is it possible to perform Pars Plana Vitrectomy cheaply and safely in resource limited environment? This is the question that I always had. Can Retina Detachment Surgery be done a low prices and safely? In trying to answer this question I had a look at the following options.

Appasamy Avit-1 Vitrectomy Machine 

Geuder Xenotron III Light Source

Appasamy Acura-1 Air Injector

Aurolab Aurocautery

Iridex 810nm Diode Laser

Khosla AAV5 Air Pressure Driven Vitrectomy Machine

Geuder G-31890 Silicone Oil Injector

Geuder G-28752 Silicone Oil Injector Extractor

Indo-German IG-6250 Silicone Oil Injector

Answer

The total cost of these equipment is about $ 30,050/= without considering freight and customs charges. Each will require disposable consumables for each patient (Vitrectomy Probe $ 150, Light Pipe $ 150, Laser Probe $ 200, Air Tubing $ 10, Diathermy Cables $ 100 and Silicone Oil $ 200) totalling some $ 810. But as the capital equipment investment is not very large, the need to recover the principal will be reduced, therefore it will keep the cost of surgery per patient relatively low, an important factor in resource limited countries such as Tanzania. Oil injection and oil extraction can be done with manual screw type devices using 10ml syringes available from Geuder (G-31890 or G-28752) or Indo-German (IG-6250).