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A simple irrigation-aspiration handpiece and coaxial cannula for use with roller pump suction devices
Fig. 1 (Nevyas). The two-stream implant forceps.
while the superior support loop is pushed posteriorly to force the glide against the upper iris, pulling the iris toward 12 o'clock so that the superior lens loop can slip behind it. The IOL is held steady in its final position as the assistant injects into the anterior chamber a small air bubble from the butterfly tubing, followed by a stream of acetylcholine. The lens is held motionless until an adequate degree of miosis is obtained. The anterior chamber is maintained with BSS bv foot pedal action, as needed. If necessary, the finaI' position of the IOL is adjusted with the same forceps. The forceps is opened slightly and withdrawn, and preplaced sutures are pulled up and tied. Additional sutures may l;>e placed.
SUMMARY The two-stream irrigating intraocular lens implanting forceps allows placement of looped pupillary or capsularly fixated IOLs with minimal intraocular manipulation. REFERENCES
1. Katz J, Kaufman HE, Goldberg EP, Sheets JW: Prevention of
endothelial damage from intraocular lens insertion. Tr Am Acad Ophthalmol Otolaryngol 83:204, 1977 2. Nevyas HJ: Irrigating intraocular lens implanting forceps with capsular blower. Am j Ophthalmol 82:502, 1976 3. Nevyas HJ: A foot-pedal controlled valve for intraocular irrigation. Am j Ophthalmol 81:682, 1976
Fig. 2 (Nevyas). Forceps tip grasping a 2-loop intraocular lens.
the tip of the right blade (Fig. 2) is a flattened 21-gauge irrigation cannula used to inflate and maintain the anterior chamber with balanced salt solution (BSS). BSS irrigation is controlled by a foot pedal valve. 3 Piggybacking the 21-gauge cannula is a shorter 23-gauge irrigation cannula for air and acetylcholine. The tip of the 21-gauge cannula reaches the midline of the pupil when the lens is held in situ. An air bubble injected through the 23-gauge cannula rises over the IOL to protect the corneal endothelium. Subsequent instillation of acetylcholine through the same cannula causes pupillary constriction. For lens implantation, the forceps is used to grasp the IOL by its two right support posts. The anterior chamber is inflated through the 21-gauge irrigating tip of the forceps. The IOL is moved slowly into the filled anterior chamber and its inferior loop is placed accurately into the capsular bag under direct visual guidance. A preplaced plastic lens guide is withdrawn
a simple irrigation-aspiration handpiece and coaxial cannula for use with roller pump suction devices Neil H. Joseph, M.D. Omaha, Nebraska
I have modified the Simcoe irrigation-aspiration coaxial cannula l by reducing the aperture of the inner steel needle and increasing the diameter of the Teflon outer sleeve. The smaller needle hole can be used with high roller pump suction; the increased internal diameter of the Teflon sleeve allows greater gravity inflow of irrigating fluid to compensate for the increased suction. Presented at the Third U.S. Intraocular Lens Symposium, Los Angeles, CA, IHarch 29, 1980. Reprint requests to Dr. joseph, 301 S. 54th Street, Omaha, NE 68132.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980
281
This modified coaxial cannula* (Fig. 1) has an irrigation-aspiration handpiece* made of three pieces of indefinitely reusable nylon fittings, two taken from in-line flash bulbs and one taken from the nylon male Luer fitting of a siliconized elastic (Silastic) intravenous tubing extension. The distal end of the handpiece is attached to the proximal end of the cannula's curved 23-gauge aspiration needle, which has a O.3-mm suction hole on its side near the tip. The needle is covered by a 16-gauge white Teflon sleeve cut from an intravenous catheter. The proximal end of this sleeve is received by Silastic tubing that has a O.04-inch internal diameter. The Teflon irrigation sleeve does not require a side hole, fills the anterior chamber rapidly, and tends to keep the chamber filled until the instrument is completely withdrawn from the eye.
REFERENCES 1. Simcoe CW: Simplified extracapsular cataract extraction. Am
Intra-Ocular Implant Soc] 5:154, 1979 2. Emery JM, Little JH: Phacoemulsification and aspiration of cataract. St Louis, CV Mosby Co, 1979, p 142 3. Patkin M: Ergonomics and the operating microscope. Adv Ophthalmol37:53, 1978 4. Patkin M: Selection and care of microsurgical instruments. Adv Ophthalmol 37:23, 1978
the fish hook needle David]. McIntyre, M.D. Bellevue, Washington Various workers have evaluated the effect of incisions, knives, scissors, multiple planes and healing factors on cataract wound closure. 1 - 3 Others have considered suture material, style and technique of placement. 4 -6 Recently, surgical keratometry7-S has been used to evaluate the effects of suture placement and the result of tension in suture tying. Most of these studies confirm White and Stern's conclusion that the least astigmatic effect is produced by the shortest suture bite. 9 Described herein is a "fish hook" needle used to close the cataract wound with short, deep su~ ture bites, thereby minimizing tissue compression and corneal distortion. The 5.5-mm long fish hook needle *(Fig. 1) repre-
Fig. IGoseph). A simple irrigation-aspiration handpiece and coaxial cannula for use with roller pump suction devices.
To minimize the chance of delayed or incomplete suction release,2 there is a hole drilled with a 23-gauge needle in the handle, on the male Luer fitting. This hole can be effectively closed by light pressure 3 •4 from the gloved index finger of the left hand. The rough perimeter of the hole is shaved with a scalpel blade. The low force required to occlude this hole and its distance from the tip of the aspiration needle allow fine two-handed control of instrument position at all times. The cannula and the handpiece may be repeatedly autoclaved and reused.
\
\
"
Fig. 1 (McIntyre). The corneoscleral fish hook needle has a short radius functional curve at its tip, supported by a longer radius carrier curve.
ACKNOWLEDGE~IENT
C. William Simcoe, M.D., demonstrated the use ofa Teflon catheter as an outer irrigating cannula in a coaxial irrigation-aspiration system.
*Available from Storz Instrument Company, St. Louis, Missouri, as cannula E4972-C and handpiece E4972-H 282
*Available from Alcon Laboratories, Inc, Fort Worth, Texas Presented at the Third u.s. Intraocular Lens Symposium, Los Angeles, CA, March 27,1980. Reprint requests to Dr. McIntyre, 1920 - 116th Ave. NE, Bellevue, WA 98004.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980
while the superior support loop is pushed posteriorly to force the glide against the upper iris, pulling the iris toward 12 o'clock so that the superior lens loop can slip behind it. The IOL is held steady in its final position as the assistant injects into the anterior chamber a small air bubble from the butterfly tubing, followed by a stream of acetylcholine. The lens is held motionless until an adequate degree of miosis is obtained. The anterior chamber is maintained with BSS bv foot pedal action, as needed. If necessary, the finaI' position of the IOL is adjusted with the same forceps. The forceps is opened slightly and withdrawn, and preplaced sutures are pulled up and tied. Additional sutures may l;>e placed.
SUMMARY The two-stream irrigating intraocular lens implanting forceps allows placement of looped pupillary or capsularly fixated IOLs with minimal intraocular manipulation. REFERENCES
1. Katz J, Kaufman HE, Goldberg EP, Sheets JW: Prevention of
endothelial damage from intraocular lens insertion. Tr Am Acad Ophthalmol Otolaryngol 83:204, 1977 2. Nevyas HJ: Irrigating intraocular lens implanting forceps with capsular blower. Am j Ophthalmol 82:502, 1976 3. Nevyas HJ: A foot-pedal controlled valve for intraocular irrigation. Am j Ophthalmol 81:682, 1976
Fig. 2 (Nevyas). Forceps tip grasping a 2-loop intraocular lens.
the tip of the right blade (Fig. 2) is a flattened 21-gauge irrigation cannula used to inflate and maintain the anterior chamber with balanced salt solution (BSS). BSS irrigation is controlled by a foot pedal valve. 3 Piggybacking the 21-gauge cannula is a shorter 23-gauge irrigation cannula for air and acetylcholine. The tip of the 21-gauge cannula reaches the midline of the pupil when the lens is held in situ. An air bubble injected through the 23-gauge cannula rises over the IOL to protect the corneal endothelium. Subsequent instillation of acetylcholine through the same cannula causes pupillary constriction. For lens implantation, the forceps is used to grasp the IOL by its two right support posts. The anterior chamber is inflated through the 21-gauge irrigating tip of the forceps. The IOL is moved slowly into the filled anterior chamber and its inferior loop is placed accurately into the capsular bag under direct visual guidance. A preplaced plastic lens guide is withdrawn
a simple irrigation-aspiration handpiece and coaxial cannula for use with roller pump suction devices Neil H. Joseph, M.D. Omaha, Nebraska
I have modified the Simcoe irrigation-aspiration coaxial cannula l by reducing the aperture of the inner steel needle and increasing the diameter of the Teflon outer sleeve. The smaller needle hole can be used with high roller pump suction; the increased internal diameter of the Teflon sleeve allows greater gravity inflow of irrigating fluid to compensate for the increased suction. Presented at the Third U.S. Intraocular Lens Symposium, Los Angeles, CA, IHarch 29, 1980. Reprint requests to Dr. joseph, 301 S. 54th Street, Omaha, NE 68132.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980
281
This modified coaxial cannula* (Fig. 1) has an irrigation-aspiration handpiece* made of three pieces of indefinitely reusable nylon fittings, two taken from in-line flash bulbs and one taken from the nylon male Luer fitting of a siliconized elastic (Silastic) intravenous tubing extension. The distal end of the handpiece is attached to the proximal end of the cannula's curved 23-gauge aspiration needle, which has a O.3-mm suction hole on its side near the tip. The needle is covered by a 16-gauge white Teflon sleeve cut from an intravenous catheter. The proximal end of this sleeve is received by Silastic tubing that has a O.04-inch internal diameter. The Teflon irrigation sleeve does not require a side hole, fills the anterior chamber rapidly, and tends to keep the chamber filled until the instrument is completely withdrawn from the eye.
REFERENCES 1. Simcoe CW: Simplified extracapsular cataract extraction. Am
Intra-Ocular Implant Soc] 5:154, 1979 2. Emery JM, Little JH: Phacoemulsification and aspiration of cataract. St Louis, CV Mosby Co, 1979, p 142 3. Patkin M: Ergonomics and the operating microscope. Adv Ophthalmol37:53, 1978 4. Patkin M: Selection and care of microsurgical instruments. Adv Ophthalmol 37:23, 1978
the fish hook needle David]. McIntyre, M.D. Bellevue, Washington Various workers have evaluated the effect of incisions, knives, scissors, multiple planes and healing factors on cataract wound closure. 1 - 3 Others have considered suture material, style and technique of placement. 4 -6 Recently, surgical keratometry7-S has been used to evaluate the effects of suture placement and the result of tension in suture tying. Most of these studies confirm White and Stern's conclusion that the least astigmatic effect is produced by the shortest suture bite. 9 Described herein is a "fish hook" needle used to close the cataract wound with short, deep su~ ture bites, thereby minimizing tissue compression and corneal distortion. The 5.5-mm long fish hook needle *(Fig. 1) repre-
Fig. IGoseph). A simple irrigation-aspiration handpiece and coaxial cannula for use with roller pump suction devices.
To minimize the chance of delayed or incomplete suction release,2 there is a hole drilled with a 23-gauge needle in the handle, on the male Luer fitting. This hole can be effectively closed by light pressure 3 •4 from the gloved index finger of the left hand. The rough perimeter of the hole is shaved with a scalpel blade. The low force required to occlude this hole and its distance from the tip of the aspiration needle allow fine two-handed control of instrument position at all times. The cannula and the handpiece may be repeatedly autoclaved and reused.
\
\
"
Fig. 1 (McIntyre). The corneoscleral fish hook needle has a short radius functional curve at its tip, supported by a longer radius carrier curve.
ACKNOWLEDGE~IENT
C. William Simcoe, M.D., demonstrated the use ofa Teflon catheter as an outer irrigating cannula in a coaxial irrigation-aspiration system.
*Available from Storz Instrument Company, St. Louis, Missouri, as cannula E4972-C and handpiece E4972-H 282
*Available from Alcon Laboratories, Inc, Fort Worth, Texas Presented at the Third u.s. Intraocular Lens Symposium, Los Angeles, CA, March 27,1980. Reprint requests to Dr. McIntyre, 1920 - 116th Ave. NE, Bellevue, WA 98004.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980