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Grooved Tying Forceps
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AMERICAN JOURNAL OF OPHTHALMOLOGY
Figure (Weinstein, Galloway, and Jones). Closedcircuit video device with illuminated view box on easel stand showing positive angiographie image from single negative frame.
video device is easily reconverted to a low-vision aid by removing the X-ray view box from the easel. REFERENCES 1. Gass, J. D. M.: A combined technique of fluorescein funduscopy and angiography of the eye. Arch. Ophthalmol. 78:455, 1967. 2. Holland, M. G.: Film strip adaptor for fluorescein angiogram projection. Am. J. Ophthalmol. 70:291, 1970.
NOVEMBER, 1984
Tying forceps currently available pro vide an extremely fine grasp, but their smooth platforms at times allow sutures to slip. Additionally, tying forceps are susceptible to misalignment during steri lization and storage. A modified tying forceps largely over comes these problems and allows the surgeon to grasp fine sutures without damaging the suture material. The design includes the groove and ridge of the Alabama forceps and the pin stabilization design of the Birks forceps. These forceps have one grooved tying platform and one ridged tying platform (Figure). The ridges of both platforms are dimpled, and this, together with the grooved configu ration, results in a superior grip with almost no suture slippage. The alignment pin and the grooved platforms provide stability so that the forceps are less likely to become misa ligned during handling. Although a crossaction design (such as the Maumenee Culibri forceps) would provide even greater stability, we have not found this modification to be necessary. We have found these forceps to be useful in tying or removing fine sutures in corneal grafts and cataract wounds. These forceps are also excellent for epilation,
GROOVED TYING FORCEPS A. E D W A R D M A U M E N E E , M.D., AND A R L O C. T E R R Y , M.D.
Wilmer Ophthalmological Institute, Johns Hopkins Hospital. Inquiries to A. Edward Maumenee, M. D., Maumenee 317, Wilmer Institute, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205.
Figure (Maumenee and Terry). Tying forceps with grooved and ridged platforms. Note the dimpled tying surface.
VOL. 98, NO. 5
LETTERS TO THE JOURNAL
and their increased stability makes them a superior instrument for office use, where more delicate forceps are readily damaged. The forceps will be available from Mentor in the near future.
SUTURE CUTTER-REMOVER DEVICE D. L O B E L ,
M.D.,
AND M. B L U M E N T H A L ,
M.D.
Maurice and Gabriela Goldschieger Eye Institute, Chaim Sheba Medical Center. Inquiries to D. Lobel, M. D., Maurice and Gabriela Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Suture removal from the eye is usually performed under a slit lamp as a two-step procedure with two instruments. First the suture is cut with a fine blade or scissors, and then the cut suture is re moved by fine-tipped forceps. Since the procedure is performed with one hand, the alternate use of two instru ments may be somewhat cumbersome. To overcome this inherent difficulty we de veloped an instrument that can be used for both cutting and removal. We combined a razor blade fragment holder and fine jeweller's forceps into one unit. A central longitudinal slot measuring 20 X 3 mm was made in the handles of fine jeweller's forceps. A 30 X 5-mm strip of stainless steel with two drilled holes was mounted on the arm of the forceps and slightly bent at the edges to fit the shape of the handle. Two stainless screws were inserted into the holes in the plate through the central slot of the handle and fastened on the
639
other arm by bolts. The front end of this strip was bent inward to a cylindrical shape that holds a 25-mm cut from the center of an 18-gauge needle. A 2 X 4-mm razor blade fragment was in serted into the shaft. By means of a special punch instru ment, razor blade fragments can be fash ioned 1 in various angles for 15 to 45 degrees. A variety of disposable blades similar to the surgical miniblades com monly used in ophthalmic surgery can be inserted into the shafts (Figure). The technique of suture removal is as follows: The instrument is held in one hand like any other microsurgical instru ment and the razor blade is advanced beyond the tips of the forceps by moving the handle plate forward with the thumb. This maneuver brings the forceps togeth er and advances the edge of the razor blade into cutting position. In this setting it is possible to cut eyelid, conjunctival, corneal, and scierai sutures as is usually done with surgical microblades. Once the suture is cut, the razor blade handle plate is pulled backward with the thumb. Thus the blade is retracted into a secure posi tion and the tips of the forceps open without removing the instrument from the field of vision. The instrument is now used as regular forceps to remove the cut suture. Since all parts of this instrument are made of stainless steel it can easily be sterilized and cared for in a routine man ner.
Figure (Lobel and Blumenthal). The device to cut and remove sutures.
AMERICAN JOURNAL OF OPHTHALMOLOGY
Figure (Weinstein, Galloway, and Jones). Closedcircuit video device with illuminated view box on easel stand showing positive angiographie image from single negative frame.
video device is easily reconverted to a low-vision aid by removing the X-ray view box from the easel. REFERENCES 1. Gass, J. D. M.: A combined technique of fluorescein funduscopy and angiography of the eye. Arch. Ophthalmol. 78:455, 1967. 2. Holland, M. G.: Film strip adaptor for fluorescein angiogram projection. Am. J. Ophthalmol. 70:291, 1970.
NOVEMBER, 1984
Tying forceps currently available pro vide an extremely fine grasp, but their smooth platforms at times allow sutures to slip. Additionally, tying forceps are susceptible to misalignment during steri lization and storage. A modified tying forceps largely over comes these problems and allows the surgeon to grasp fine sutures without damaging the suture material. The design includes the groove and ridge of the Alabama forceps and the pin stabilization design of the Birks forceps. These forceps have one grooved tying platform and one ridged tying platform (Figure). The ridges of both platforms are dimpled, and this, together with the grooved configu ration, results in a superior grip with almost no suture slippage. The alignment pin and the grooved platforms provide stability so that the forceps are less likely to become misa ligned during handling. Although a crossaction design (such as the Maumenee Culibri forceps) would provide even greater stability, we have not found this modification to be necessary. We have found these forceps to be useful in tying or removing fine sutures in corneal grafts and cataract wounds. These forceps are also excellent for epilation,
GROOVED TYING FORCEPS A. E D W A R D M A U M E N E E , M.D., AND A R L O C. T E R R Y , M.D.
Wilmer Ophthalmological Institute, Johns Hopkins Hospital. Inquiries to A. Edward Maumenee, M. D., Maumenee 317, Wilmer Institute, Johns Hopkins Hospital, 600 N. Wolfe St., Baltimore, MD 21205.
Figure (Maumenee and Terry). Tying forceps with grooved and ridged platforms. Note the dimpled tying surface.
VOL. 98, NO. 5
LETTERS TO THE JOURNAL
and their increased stability makes them a superior instrument for office use, where more delicate forceps are readily damaged. The forceps will be available from Mentor in the near future.
SUTURE CUTTER-REMOVER DEVICE D. L O B E L ,
M.D.,
AND M. B L U M E N T H A L ,
M.D.
Maurice and Gabriela Goldschieger Eye Institute, Chaim Sheba Medical Center. Inquiries to D. Lobel, M. D., Maurice and Gabriela Goldschleger Eye Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Suture removal from the eye is usually performed under a slit lamp as a two-step procedure with two instruments. First the suture is cut with a fine blade or scissors, and then the cut suture is re moved by fine-tipped forceps. Since the procedure is performed with one hand, the alternate use of two instru ments may be somewhat cumbersome. To overcome this inherent difficulty we de veloped an instrument that can be used for both cutting and removal. We combined a razor blade fragment holder and fine jeweller's forceps into one unit. A central longitudinal slot measuring 20 X 3 mm was made in the handles of fine jeweller's forceps. A 30 X 5-mm strip of stainless steel with two drilled holes was mounted on the arm of the forceps and slightly bent at the edges to fit the shape of the handle. Two stainless screws were inserted into the holes in the plate through the central slot of the handle and fastened on the
639
other arm by bolts. The front end of this strip was bent inward to a cylindrical shape that holds a 25-mm cut from the center of an 18-gauge needle. A 2 X 4-mm razor blade fragment was in serted into the shaft. By means of a special punch instru ment, razor blade fragments can be fash ioned 1 in various angles for 15 to 45 degrees. A variety of disposable blades similar to the surgical miniblades com monly used in ophthalmic surgery can be inserted into the shafts (Figure). The technique of suture removal is as follows: The instrument is held in one hand like any other microsurgical instru ment and the razor blade is advanced beyond the tips of the forceps by moving the handle plate forward with the thumb. This maneuver brings the forceps togeth er and advances the edge of the razor blade into cutting position. In this setting it is possible to cut eyelid, conjunctival, corneal, and scierai sutures as is usually done with surgical microblades. Once the suture is cut, the razor blade handle plate is pulled backward with the thumb. Thus the blade is retracted into a secure posi tion and the tips of the forceps open without removing the instrument from the field of vision. The instrument is now used as regular forceps to remove the cut suture. Since all parts of this instrument are made of stainless steel it can easily be sterilized and cared for in a routine man ner.
Figure (Lobel and Blumenthal). The device to cut and remove sutures.