36.
Combination Treatment Including a Limited Vitrectomy
Frank H. J. Koch (Frankfurt / Main)
Purpose: To introduce a combination treatment strategy including a portable single entry
step 23 gauge vitrectomy instrument for simultaneous drug delivery / infusion and aspiration /
vitreous cutting all with the same probe tip.
Methods: This instrument has separate drug delivery or infusion of any substance and simultaneous
aspiration/vitreous cutting channel which end in the same single 23 gauge probe needle
tip. Pars plana vitrectomy can thus be performed displacing the conjunctiva through an
oblique self-sealing sclerotomy. This vitrectomy requires peribulbar or tropical anaesthesia.
Aspiration and injection are performed by an assistant therefore allowing for anterior, core and
central vitrectomy with any desired volume being removed. Illumination of the probe needle tip
can be achieved by the microscope (in an O.R. or A.S.C. setting), slit lamp (with or without a
flat contact viewing lens) or with an indirect ophthalmoscope (with a viewing lens). The cutting
rate is up to 360 C.P.M. delivered by compact battery operated power controlling unit.
The Intrector® allows synchronic aspiration / injection through two different channels in a single tip.
Results: By incorporating a core pars plana vitrectomy into the drug injection regimen the need for retreatment has been
drastically reduced (see references).
Conclusions: Various vitreo-retinal procedures like combined pharmacosurgical procedures for ARMD. DM or Retinal
Venous occlusion can be conducted in an effective and controlled manner. Other indication for uveitis, endophthalmitis, or
a modified gas injection during pneumatic retinopexy are also possible, making a vitrectomy (intrectomy) with the Intrector®
a simple, less costly, office based, A.S.C., or operating room procedure.
References:
S. Shukla1, M.J. Koss2, F.H.J. Koch2, R.G. Josephberg1. 1Ophthalmology, New York Medical College, Valhalla, NY; 2Ophthalmology, University of
Frankfurt, Frankfurt, Germany. „Quadruple Therapy and the Postulated Role of Posterior Vitreous detachment in the Treatment of Exudative Age related
macular Degenaration „ Poster A534 ARVO 2008.
A. Sener1, M.J. Koss2, F. Al-Sarireh2, S. Scholtz2, P. Singh2, F.H. Koch2. 1Ophthalmology, Artemis-Eyer-Clinics, Dillenburg, Germany; 2Department of
Ophthalmology, Vitreo-Retinal Surgery, Johann-Wolfgang Goethe University Frankfurt/Main, Germany. “Combined intravitreal Triple Therapy (TT) in
retinal vein occlusion: results of a pilot study” Poster A468 ARVO 2008.
H. Naser1, M.J. Koss1, F. Al-Sarireh1, A. Sener2, S. Scholtz1, P. Singh1, F.H. Koch1. 1Department of Ophthalmology, Vitreo-Retinal Surgery, Johann-
Wolfgang Goethe University Frankfurt/Main, Germany; 2Ophthalmology, MVZ Dillenburg, Dillenburg, Germany. “Triple Therapy in Diabetic
Retinopathy” Poster A561 ARVO 2008.