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The capsule amputator spatula
The capsule amp uta tor spatula Michael E. Lieppman, M.D. Long Beach, California
ABSTRACT Anterior capsular remnants cause various early and late cataract and intraocular lens implant complications. The complete removal of any large anterior capsular tags is easily accomplished with a 0.295 mm spatula, designed to cut capsular tags entrapped in the 0.3 mm aspiration port of any extracapsular extractor, using a "hole-punching" concept. Key Words: capsule, extracapsular cataract surgery, instrument, spatula
cases, instruments and notes
266
AM INTRA-OCULAH
IMPLA~T
A difficult problem in extracapsular surgery is the incomplete anterior capsulotomy. Anterior capsular tags should be removed, but their removal using current techniques risks the loss of an intact posterior capsule. Problems incurred by leaving capsular remnants include: 1. inadequate cortex removal (capsule tag blocks aspiration of cortex) 2. pupillary irregularities (synechiae) 3. inaccurate placement of posterior chamber lenses "in" or "out" of the bag 4. capsular fibrosis 5. early clouding of the posterior capsule 6. migration of the posterior lens implant 7. corneal decompensation secondary to capsular touch 8. diplopia due to a capsular tag in the pupillary area. The use of fine forceps to pull on the tags ("toilet tissue trick") risks capsular integrity. The use of fine scissors inside the anterior chamber risks corneal touch. The use of available spatulas in conjunction with the aspiration-irrigation handpieces currently in use requires repetitive and often futile scraping maneuvers to amputate unwanted capsular remnants. The capsule amputator spatula provides a rapid removal of the capsule remnant. It can be introduced into the sutured wound or an ab externo corneal incision while the irrigation-aspiration tip engages the capsular remnant with minimal traction and maximum control. The 0.3 mm aperture contains the capsular tag at its base while the 0.295 mm sharp spatula tip is placed into the aperture. The teminal 0.5 mm of the spatula has a 20 degree bevel that allows easy insertion into the SOC J-VOL. H, SUMMER 19H2
aperture. One or two hole-punching maneuvers with the spatula amputate the tag, which is quickly aspirated out of the eye (Figs. 1 and 2). The instrument is available through Katena (K3251) and Storz (SP723314).
Improved technique for secondary anterior chamber lens insertion Stephen H. Johnson, M.D. Richard P. Kratz, M.D. Newport Beach, California
ABSTRACT An improved technique for secondary anterior chamber lens implantation is presented. This technique eliminates the problems of postoperative ocular tenderness and late corneal decompensation due to implant motion. Fig. 1. The spatula configuration (left) is shown next to an irrigation-aspiration tip to demonstrate how closely the 0.295 mm spatula tip approximates the size of the 0.3 mm aspiration port.
Fig. 2. While the aspiration port is blocked by an anterior capsular tag, the spatula is introduced through a #51 Beaver ab externo corneal incision and placed into the port in an "in and out" motion to amputate the capsular tag at its base. The spatula is then immediately withdrawn. Any trapped cortex in the area of the aspiration port is effortlessly aspirated.
Presented at the U.S. Intraocular Lens Symposium, Los Angeles, California, April, 1982. Dr. Lieppman is Assistant Clinical Professor, Unit;ersity of California, Irvine , California. The presentation of this new instrument is not supported by any company or organization. The author does not profit from its sale. Reprint requests to Michael E. Lieppman, M.D., 1760 Termino, Long Beach, California 90804.
Key Words: Anterior chamber lens, secondary lens implantation, intraocular lens implantation
Eyes with anterior chamber lenses are subject to certain problems unless the length of the anterior chamber lens accurately matches the diameter of the anterior chamber angle. If the implant is too long, the eye will remain tender even years after surgery. If it is too short, it rotates in a propeller-like fashion, ultimately resulting in corneal decompensation if nothing is done. Measuring the "white to white diameter," as advocated by Mr. Peter Choyce,l using a dipstick similar to that designed by Dr. Jerald Tennant,2 or other device 3 are methods currently employed by surgeons to determine implant length, but they are not completely successful. Our technique permits the surgeon to implant an anterior chamber lens and eliminates the problems of postoperative tenderness and implant mobility.
METHODS The "white to white" horizontal diameter is measured. To this measurement we add 0.75 millimeters to determine the lens we will use. A fornix based peritomy is performed at 12 o'clock, and hemostasis achieved with cautery. A one-half depth scleral groove, 7 mm long, is made 2 mm posterior to, and parallel to, the surgical limbus superiorly. This groove is converted to an anterior scleral flap which extends anteriorly to the limbal vascular arcades. The anterior
AM INTRA-OCULAR IMPLANT SOC J-VOL. 8, SUMMER 1982
267
ABSTRACT Anterior capsular remnants cause various early and late cataract and intraocular lens implant complications. The complete removal of any large anterior capsular tags is easily accomplished with a 0.295 mm spatula, designed to cut capsular tags entrapped in the 0.3 mm aspiration port of any extracapsular extractor, using a "hole-punching" concept. Key Words: capsule, extracapsular cataract surgery, instrument, spatula
cases, instruments and notes
266
AM INTRA-OCULAH
IMPLA~T
A difficult problem in extracapsular surgery is the incomplete anterior capsulotomy. Anterior capsular tags should be removed, but their removal using current techniques risks the loss of an intact posterior capsule. Problems incurred by leaving capsular remnants include: 1. inadequate cortex removal (capsule tag blocks aspiration of cortex) 2. pupillary irregularities (synechiae) 3. inaccurate placement of posterior chamber lenses "in" or "out" of the bag 4. capsular fibrosis 5. early clouding of the posterior capsule 6. migration of the posterior lens implant 7. corneal decompensation secondary to capsular touch 8. diplopia due to a capsular tag in the pupillary area. The use of fine forceps to pull on the tags ("toilet tissue trick") risks capsular integrity. The use of fine scissors inside the anterior chamber risks corneal touch. The use of available spatulas in conjunction with the aspiration-irrigation handpieces currently in use requires repetitive and often futile scraping maneuvers to amputate unwanted capsular remnants. The capsule amputator spatula provides a rapid removal of the capsule remnant. It can be introduced into the sutured wound or an ab externo corneal incision while the irrigation-aspiration tip engages the capsular remnant with minimal traction and maximum control. The 0.3 mm aperture contains the capsular tag at its base while the 0.295 mm sharp spatula tip is placed into the aperture. The teminal 0.5 mm of the spatula has a 20 degree bevel that allows easy insertion into the SOC J-VOL. H, SUMMER 19H2
aperture. One or two hole-punching maneuvers with the spatula amputate the tag, which is quickly aspirated out of the eye (Figs. 1 and 2). The instrument is available through Katena (K3251) and Storz (SP723314).
Improved technique for secondary anterior chamber lens insertion Stephen H. Johnson, M.D. Richard P. Kratz, M.D. Newport Beach, California
ABSTRACT An improved technique for secondary anterior chamber lens implantation is presented. This technique eliminates the problems of postoperative ocular tenderness and late corneal decompensation due to implant motion. Fig. 1. The spatula configuration (left) is shown next to an irrigation-aspiration tip to demonstrate how closely the 0.295 mm spatula tip approximates the size of the 0.3 mm aspiration port.
Fig. 2. While the aspiration port is blocked by an anterior capsular tag, the spatula is introduced through a #51 Beaver ab externo corneal incision and placed into the port in an "in and out" motion to amputate the capsular tag at its base. The spatula is then immediately withdrawn. Any trapped cortex in the area of the aspiration port is effortlessly aspirated.
Presented at the U.S. Intraocular Lens Symposium, Los Angeles, California, April, 1982. Dr. Lieppman is Assistant Clinical Professor, Unit;ersity of California, Irvine , California. The presentation of this new instrument is not supported by any company or organization. The author does not profit from its sale. Reprint requests to Michael E. Lieppman, M.D., 1760 Termino, Long Beach, California 90804.
Key Words: Anterior chamber lens, secondary lens implantation, intraocular lens implantation
Eyes with anterior chamber lenses are subject to certain problems unless the length of the anterior chamber lens accurately matches the diameter of the anterior chamber angle. If the implant is too long, the eye will remain tender even years after surgery. If it is too short, it rotates in a propeller-like fashion, ultimately resulting in corneal decompensation if nothing is done. Measuring the "white to white diameter," as advocated by Mr. Peter Choyce,l using a dipstick similar to that designed by Dr. Jerald Tennant,2 or other device 3 are methods currently employed by surgeons to determine implant length, but they are not completely successful. Our technique permits the surgeon to implant an anterior chamber lens and eliminates the problems of postoperative tenderness and implant mobility.
METHODS The "white to white" horizontal diameter is measured. To this measurement we add 0.75 millimeters to determine the lens we will use. A fornix based peritomy is performed at 12 o'clock, and hemostasis achieved with cautery. A one-half depth scleral groove, 7 mm long, is made 2 mm posterior to, and parallel to, the surgical limbus superiorly. This groove is converted to an anterior scleral flap which extends anteriorly to the limbal vascular arcades. The anterior
AM INTRA-OCULAR IMPLANT SOC J-VOL. 8, SUMMER 1982
267