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Modified Vitreoretinal Pics and Spatulas
610
May, 1985
AMERICAN JOURNAL OF OPHTHALMOLOGY
through the opening while irrigating with a balanced salt solution. The typical result is a small iridotomy in the shape of an inverted V (Fig. 2). To date, there has been no known inadvertent cutting of the posterior capsule or other significant complications.
Modified Spatulas
Vitreoretinal
Pies and
R. Joseph Olk, M.D., and Richard F. Escoffery, M.D. Fig. 2 (Shields). Typical appearance of iridotomy created by scissor-forceps during extracapsular cataract extraction and posterior chamber intraocular lens implantation.
blade is one fine forceps tooth, at a right angle to the blade (Fig. 1). The teeth overlap to allow complete closure of the blades. When the scissors are fully open, the distance between the tips of the two teeth is 3 mm. This modification allows the creation of a peripheral iridotomy in a single pinching-cutting motion without pulling iris outside the eye. The teeth grasp the iris, causing the intervening tissue to be pinched up between the scissor blades and cut as the scissors close. In the first 30 cases there were technical difficulties, the most common of which was an incomplete iridotomy, but eventually the following steps led to reproducible iridotomies. The iridotomy is performed after implantation of the posterior chamber lens but while the anterior chamber still contains air or sodium hyaluronate and the corneoscleral wound is only partially closed with two sutures, 7 mm apart. The haptics of the intraocular lens are rotated to a horizontal position to avoid being cut during the iridotomy. With the blades closed, the scissors are introduced into the anterior chamber through the corneoscleral incision. The curved blades of the scissors are oriented so that the tips are directed down toward the iris. This orientation allows the teeth to engage the iridic stroma in a nearly perpendicular fashion and in a mid-peripheral location. Before the scissors touch the iris, the blades are allowed to open fully. The tips of the scissors are then pressed gently against the stroma, and the blades are closed tightly, pinching the iris between the blades and simultaneously cutting the iridotomy. Next, the blades must be opened fully before they are withdrawn from the eye to avoid pulling the iris out with the instrument. The patency of the iridotomy can be tested by passing a fine irrigation tip
Department of Ophthalmology, Washington University School of Medicine. Inquiries to R. Joseph Olk, M.D., Retina Consultants Ltd., 4949 Barnes Hospital Plaza, Suite 17413 East Pavilion, St. Louis, MO 63110.
All of the several instruments presently available for membrane peeling in premacular fibroplasia and to assist in delamination techniques in vitreous surgery have some limitations. We have designed modified vitreoretinal pies and spatulas with angles of 110, 130, and 150 degrees that have many potential advantages.
Figure (Olk and Escoffery). Magnified view of 130-degree modified vitreoretinal spatula and pic. Note flattened upper surface on tip of pic.
Vol. 99, No.5
Letters to the Journal
Other vitreoretinal pies available are the Michels' pic and the Berkley Bioengineering pic. The Michels' pic' can be used to engage the edge of a highly elevated membrane or ridge, but it is difficult to use on flat or diaphanous membranes because the tip is round, making it hard to engage the edge of these membranes; also, because of the pic's 90-degree angle, the heel of the pic can inadvertently crease the retina. Also, we have found the Michels' spatula to be cumbersome. The Berkley Bioengineering illuminated membrane pic" is useful in peeling flat or diaphanous membranes with no definite edge. However, this instrument is cumbersome because it has a short shaft and a short handle, and is available with only one angle of approximately 120 to 130 degrees. A bent 20-gauge sharp needle attached to the end of a tuberculin syringe can be used for membrane peeling. However, there is a risk of puncturing the retina with the sharp tip or lacerating the retina with the edge of the needle. Because of the limitations of available vitreoretinal instruments, we designed modified pics and spatulas which we find extremely useful in membrane peeling in premacular fibroplasia and for assisting in delamination techniques for proliferative vitreoretinopathy (Figure). • In addition to availability in various angles, the tips of the pies have a flattened upper surface that helps engage the edge of diaphanous membranes. The modified vitreoretinal pies and spatulas are
Figure (Drews). Micro instruments on miniature handles.
611
made of stainless steel and have a dull matte finish to reduce reflections from the intraocular light pipe. •Available from the Storz Instrument Company, St. Louis, Missouri.
References 1. Michels, R. G., Rice, T. A., and Ober, R. R.: Vitreoretinal dissection instruments. Am. J. Ophthalmoi. 87:836, 1979. 2. O'Malley, c., and Heintz, R. M., Sr.: Orientation of vitrectomy instruments, ideas and practicalities. In Irvine, A. R., and O'Malley, C. (eds.): Advances in Vitreous Surgery. Springfield, Charles C Thomas, 1976.
Intraocular Micro Miniature Handles
Instruments
on
Robert C. Drews, M.D. Department of Ophthalmology, Washington University School of Medicine. Inquiries to Robert C. Drews, M.D., 211 N. Meramec Ave., Clayton, MO 63105.
The mounting of the various tips used for intraocular manipulation on very short, fine, round, light, knurled handles (Figure) allows the instruments to
May, 1985
AMERICAN JOURNAL OF OPHTHALMOLOGY
through the opening while irrigating with a balanced salt solution. The typical result is a small iridotomy in the shape of an inverted V (Fig. 2). To date, there has been no known inadvertent cutting of the posterior capsule or other significant complications.
Modified Spatulas
Vitreoretinal
Pies and
R. Joseph Olk, M.D., and Richard F. Escoffery, M.D. Fig. 2 (Shields). Typical appearance of iridotomy created by scissor-forceps during extracapsular cataract extraction and posterior chamber intraocular lens implantation.
blade is one fine forceps tooth, at a right angle to the blade (Fig. 1). The teeth overlap to allow complete closure of the blades. When the scissors are fully open, the distance between the tips of the two teeth is 3 mm. This modification allows the creation of a peripheral iridotomy in a single pinching-cutting motion without pulling iris outside the eye. The teeth grasp the iris, causing the intervening tissue to be pinched up between the scissor blades and cut as the scissors close. In the first 30 cases there were technical difficulties, the most common of which was an incomplete iridotomy, but eventually the following steps led to reproducible iridotomies. The iridotomy is performed after implantation of the posterior chamber lens but while the anterior chamber still contains air or sodium hyaluronate and the corneoscleral wound is only partially closed with two sutures, 7 mm apart. The haptics of the intraocular lens are rotated to a horizontal position to avoid being cut during the iridotomy. With the blades closed, the scissors are introduced into the anterior chamber through the corneoscleral incision. The curved blades of the scissors are oriented so that the tips are directed down toward the iris. This orientation allows the teeth to engage the iridic stroma in a nearly perpendicular fashion and in a mid-peripheral location. Before the scissors touch the iris, the blades are allowed to open fully. The tips of the scissors are then pressed gently against the stroma, and the blades are closed tightly, pinching the iris between the blades and simultaneously cutting the iridotomy. Next, the blades must be opened fully before they are withdrawn from the eye to avoid pulling the iris out with the instrument. The patency of the iridotomy can be tested by passing a fine irrigation tip
Department of Ophthalmology, Washington University School of Medicine. Inquiries to R. Joseph Olk, M.D., Retina Consultants Ltd., 4949 Barnes Hospital Plaza, Suite 17413 East Pavilion, St. Louis, MO 63110.
All of the several instruments presently available for membrane peeling in premacular fibroplasia and to assist in delamination techniques in vitreous surgery have some limitations. We have designed modified vitreoretinal pies and spatulas with angles of 110, 130, and 150 degrees that have many potential advantages.
Figure (Olk and Escoffery). Magnified view of 130-degree modified vitreoretinal spatula and pic. Note flattened upper surface on tip of pic.
Vol. 99, No.5
Letters to the Journal
Other vitreoretinal pies available are the Michels' pic and the Berkley Bioengineering pic. The Michels' pic' can be used to engage the edge of a highly elevated membrane or ridge, but it is difficult to use on flat or diaphanous membranes because the tip is round, making it hard to engage the edge of these membranes; also, because of the pic's 90-degree angle, the heel of the pic can inadvertently crease the retina. Also, we have found the Michels' spatula to be cumbersome. The Berkley Bioengineering illuminated membrane pic" is useful in peeling flat or diaphanous membranes with no definite edge. However, this instrument is cumbersome because it has a short shaft and a short handle, and is available with only one angle of approximately 120 to 130 degrees. A bent 20-gauge sharp needle attached to the end of a tuberculin syringe can be used for membrane peeling. However, there is a risk of puncturing the retina with the sharp tip or lacerating the retina with the edge of the needle. Because of the limitations of available vitreoretinal instruments, we designed modified pics and spatulas which we find extremely useful in membrane peeling in premacular fibroplasia and for assisting in delamination techniques for proliferative vitreoretinopathy (Figure). • In addition to availability in various angles, the tips of the pies have a flattened upper surface that helps engage the edge of diaphanous membranes. The modified vitreoretinal pies and spatulas are
Figure (Drews). Micro instruments on miniature handles.
611
made of stainless steel and have a dull matte finish to reduce reflections from the intraocular light pipe. •Available from the Storz Instrument Company, St. Louis, Missouri.
References 1. Michels, R. G., Rice, T. A., and Ober, R. R.: Vitreoretinal dissection instruments. Am. J. Ophthalmoi. 87:836, 1979. 2. O'Malley, c., and Heintz, R. M., Sr.: Orientation of vitrectomy instruments, ideas and practicalities. In Irvine, A. R., and O'Malley, C. (eds.): Advances in Vitreous Surgery. Springfield, Charles C Thomas, 1976.
Intraocular Micro Miniature Handles
Instruments
on
Robert C. Drews, M.D. Department of Ophthalmology, Washington University School of Medicine. Inquiries to Robert C. Drews, M.D., 211 N. Meramec Ave., Clayton, MO 63105.
The mounting of the various tips used for intraocular manipulation on very short, fine, round, light, knurled handles (Figure) allows the instruments to