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A Device for Centering Corneal Grafts*
617
NOTES, CASES, INSTRUMENTS A DEVICE FOR CENTERING CORNEAL GRAFTS* MIGUEL MARTINEZ,
M.D.
New York Although several instruments have been designed to simplify the procedure, the cen tering of corneal grafts remains a problem. A glance through the illustrations of any article on keratoplasty will show a number of cases in which the technical success of the graft is marred by the poor cosmetic and op tical effect of an off-center graft. Most instruments now available for this purpose rely on centering over the pupil. * From the laboratory of The Eye Bank for Sight Restoration, Inc., Manhattan Eye, Ear and Throat Hospital.
1
This is difficult in cases with central scarring so dense that the pupil is not clearly visible. Instruments designed to mark the cornea are not always sharp enough to mark a soft cornea and then, too, the marks are out of sight when the trephine is in place, or nearly so. We have overcome most of these difficul ties by devising a disc, cut from gelfilm, which is centered in relation to the limbus. The outside diameter of the disc is 10 mm. and the hole in the center is 5.0, 6.0, or 7.0 mm., according to the desired size of the graft. In the operating room the discs are steri lized in alcohol, then soaked for about five minutes in normal saline to increase their pliability. After this soaking, the disc is al-
2
Λ 3
\% Fig. 1 (Martinez). A device for centering corneal grafts.
NOTES, CASES, INSTRUMENTS
618
lowed to dry a little, since it will mold and adhere to the cornea better if both the disc and the cornea are a little dry. The disc is then placed on the cornea, using the limbus as a guide. The trephine is placed firmly on the cornea through the cen tral hole. When the trephine is in place, the disc can be grasped with forceps and a slight tug will break the rim of gelfilm so that it can be lifted away without removing the trephine after its initial placement. This device has two great advantages in that it is simple to construct and easy to use. We have found it superior to other centering devices and more accurate than centering by sight alone. 210 East 64th Street (21). A U S E F U L STRETCHER* FOR TRANSPORTATION OF THE INTRAOCULAR SURGICAL PATIENT FREDERICK
C.
WUEST, LIEUT.
(MC) U.S.N.
Oakland, California
The purpose of this report is to describe a stretcher which has been of great value in transporting patients from the operating ta ble following surgery. It has been used for all patients undergoing intraocular surgery where it is of the utmost importance that they be as immobile as possible and not be subjected to stresses while being moved. Also, whenever general anesthesia is used, this stetcher makes the transportation of the recovering patient extremely easy. It is cer tain that this stetcher could be used exten sively in any surgical operating room, espe cially in hospitals where the patient's bed is not used as the operating table. Its use could be extended to moving the medicated senile or infirm patient from the bed to the operat ing room ; also, in the transportation of the * From the Ophthalmology Branch, EENT Serv ice, U. S. Naval Hospital. The opinions or assertions expressed herein are those of the writer and are not to be construed as official or as necessarily reflecting the views of the Medical Department of the Navy or the Naval Service at large.
Fig. 1 (Wuest). Stretcher assembled.
comatose patient or one suffering from trauma to minimize handling and stresses. The stretcher consists of two pieces of heavy canvas, 15 in. wide by 80 in. long; two light metal or wooden stretcher poles; and finally, a strip of stainless steel 1.0 in. wide by 80 in. long, with a metal ring at one end (fig. 1). The canvas has a continuous loop on the outer long edge, through which a stretcher pole can be placed. The center long edge has eight two-in. loops of heavy canvas, spaced about 10 in. apart. These loops are placed on the second piece of canvas so they can alternate with the loops of the first. The long metal strip can be threaded through these alternate loops of the canvas, thus making a full stretcher (fig. 1). It is recom mended that the metal strip be of chromeplated stainless steel or any other polished, smooth metal, since these slide more easily and facilitate removal. For surgery, the assembled stretcher is placed on the operating table with the poles removed. The ring in the metal strip should
NOTES, CASES, INSTRUMENTS A DEVICE FOR CENTERING CORNEAL GRAFTS* MIGUEL MARTINEZ,
M.D.
New York Although several instruments have been designed to simplify the procedure, the cen tering of corneal grafts remains a problem. A glance through the illustrations of any article on keratoplasty will show a number of cases in which the technical success of the graft is marred by the poor cosmetic and op tical effect of an off-center graft. Most instruments now available for this purpose rely on centering over the pupil. * From the laboratory of The Eye Bank for Sight Restoration, Inc., Manhattan Eye, Ear and Throat Hospital.
1
This is difficult in cases with central scarring so dense that the pupil is not clearly visible. Instruments designed to mark the cornea are not always sharp enough to mark a soft cornea and then, too, the marks are out of sight when the trephine is in place, or nearly so. We have overcome most of these difficul ties by devising a disc, cut from gelfilm, which is centered in relation to the limbus. The outside diameter of the disc is 10 mm. and the hole in the center is 5.0, 6.0, or 7.0 mm., according to the desired size of the graft. In the operating room the discs are steri lized in alcohol, then soaked for about five minutes in normal saline to increase their pliability. After this soaking, the disc is al-
2
Λ 3
\% Fig. 1 (Martinez). A device for centering corneal grafts.
NOTES, CASES, INSTRUMENTS
618
lowed to dry a little, since it will mold and adhere to the cornea better if both the disc and the cornea are a little dry. The disc is then placed on the cornea, using the limbus as a guide. The trephine is placed firmly on the cornea through the cen tral hole. When the trephine is in place, the disc can be grasped with forceps and a slight tug will break the rim of gelfilm so that it can be lifted away without removing the trephine after its initial placement. This device has two great advantages in that it is simple to construct and easy to use. We have found it superior to other centering devices and more accurate than centering by sight alone. 210 East 64th Street (21). A U S E F U L STRETCHER* FOR TRANSPORTATION OF THE INTRAOCULAR SURGICAL PATIENT FREDERICK
C.
WUEST, LIEUT.
(MC) U.S.N.
Oakland, California
The purpose of this report is to describe a stretcher which has been of great value in transporting patients from the operating ta ble following surgery. It has been used for all patients undergoing intraocular surgery where it is of the utmost importance that they be as immobile as possible and not be subjected to stresses while being moved. Also, whenever general anesthesia is used, this stetcher makes the transportation of the recovering patient extremely easy. It is cer tain that this stetcher could be used exten sively in any surgical operating room, espe cially in hospitals where the patient's bed is not used as the operating table. Its use could be extended to moving the medicated senile or infirm patient from the bed to the operat ing room ; also, in the transportation of the * From the Ophthalmology Branch, EENT Serv ice, U. S. Naval Hospital. The opinions or assertions expressed herein are those of the writer and are not to be construed as official or as necessarily reflecting the views of the Medical Department of the Navy or the Naval Service at large.
Fig. 1 (Wuest). Stretcher assembled.
comatose patient or one suffering from trauma to minimize handling and stresses. The stretcher consists of two pieces of heavy canvas, 15 in. wide by 80 in. long; two light metal or wooden stretcher poles; and finally, a strip of stainless steel 1.0 in. wide by 80 in. long, with a metal ring at one end (fig. 1). The canvas has a continuous loop on the outer long edge, through which a stretcher pole can be placed. The center long edge has eight two-in. loops of heavy canvas, spaced about 10 in. apart. These loops are placed on the second piece of canvas so they can alternate with the loops of the first. The long metal strip can be threaded through these alternate loops of the canvas, thus making a full stretcher (fig. 1). It is recom mended that the metal strip be of chromeplated stainless steel or any other polished, smooth metal, since these slide more easily and facilitate removal. For surgery, the assembled stretcher is placed on the operating table with the poles removed. The ring in the metal strip should