- Email: [email protected]
The fish hook needle
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side hole, fills the anterior chamber rapidly, and tends to keep the chamber filled until the instrument is completely withdrawn from the eye.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
sents a new bicurved generation of the currently available super sharp suturing needles. The first or functional1.5-mm curve at the needle tip has a short radius for placement of the tissue bite. The second or carrier curve is the conventional long radius curve throughout the body of the needle which facilitates its manufacture, suture mounting and handling. The bicurved needle is used with a technique distinctly different from that used with the conventional needles. The needle holder must be rolled in an exaggerated motion between thumb and fingers rather than with minimal wrist movement. The tissue is entered without forceps eversion as the needle tip points directly downwards (Fig. 2). The full rolling motion of the needle holder causes the functional curve to arc through both sides of the wound. Forceps are used only for backup as the needle emerges from the proximal side. As the carrier curve passes through the tissue the wound's surface gapes harmlessly, falling back together as the needle completes its passage.
There is one significant inconvenience of the fish hook needle: it acts very much like a grappling hook and cannot be dragged by its suture across anything without snagging everything it passes and possibly causing the suture to break. This hazard may be avoided by picking up the needle.
SUMMARY The bicurved fish hook needle allows placement of consistently short bites to close cataract, keratoplasty or traumatic corneal wounds with minimal tissue compression and astigmatism. The technique of handling is different than that for traditional single-radius needles, however it is easily learned. This bicurved needle should find wide application in other microsurgical procedures, such as vascular anastomosis, tuboplasty and vasovasostomy.
II
/
Fig. 2 (Mcintyre). Top left: The fish hook needle begins its passage with its tip perpendicular to the tissue. Top right: The straight, locking needle holder is rolled to follow the arc of the functional curve. Bottom right: The needle holder continues to follow the short radius arc and the distal wound lip everts as the needle tip passes up through proximal tissue. Bottom left: As the fish hook needle is extracted, passage of the carrier curve causes wound eversion. AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980
283
ACKNOWLEDCE~ENT
Trese Rand and John Bergstrom provided the illustrations.
REFERENCES 1. Heller MD, Irvine SR, Straatsma BR et al: Wound healing aft-
er cataract extraction and position of the vitreous in aphakic eyes as studied postmortem. Trans Am Ophthalmol Soc 69:245, 1971 Troutman RC: Microsurgical control of corneal astigmatism in cataract and keratoplasty. Trans Am Acad Ophthalmol OtolaryngoI77:563, 1973 Jervey ED: Clear corneal section and cataract extraction. Southern Med ] 69: 170, 1976 Floyd C: Changes in the corneal curvature following cataract extraction. Am] Ophthalmol 34: 1525, 1951 Jaffe NS, Clayman HM: The pathophysiology of corneal astigmatism after cataract extraction. Trans Am Acad Ophthalmol Otolaryngol 79:615, 1975 Luntz MH, Livingston DC: Astigmatism in cataract surgery. BrJ Ophthalmol 61:360, 1977 Troutman RC: Microsurgery of the Anterior Segment of the Eye. St Louis, CV Mosby Co, 1974 Cravy TV: Calculation of the change in corneal astigmatism following cataract extraction. Ophthalmic Surg 10:38, 1979 White JH, Stern RU: A theoretical consideration of suturing technique. Ann Ophthalmol 3:509, 1971
2. 3. 4. 5. 6. 7. 8. 9.
has an outer cutting sleeve which passes over a side port (Fig. 2). The inner lumen of the instrument is connected to siliconized elastic (Silastic) aspiration tubing. The cutting mechanism is activated by light squeeze/release of the spring handle. Replacement fluid inflow can be coaxial (not shown) or through separate entry.
Fig. 2 (Simcoe). Side port for aspiration of vitreous.
anterior segment vitrectomy apparatus C. William Simcoe, M.D. Tulsa, Oklahoma A need exists for a simple, reliable manually operated autoclavable anterior segment vitrectomy apparatus. The vitrectomy instrument* shown in Fig. 1
retrieval and replacement of an iris plane implant dislocated five years previously into the vitreous cavity Charles Dyson, M.D. London, Canada CASE REPORT A 57-year-old railway crane operator examined in
Fig. 1 (Simcoe). Anterior segment vitrectomy apparatus.
*Availablefrom Storz Instrument Company, St. Louis, Missouri Reprint requests to Dr. Simcoe, Utica Square Medical Center, Suite 110, Tulsa, OK 74114. 284
December 1978 had a cataract OD which reduced vision in that eye to hand motion. Five years previously, this man had undergone intracapsular cataract surgery and primary implantation of an iris plane (Copeland) lens in the left eye. Postoperative examination showed that the lens had dislocated into the vitreous. No attempt was made to reposition the lens at that time, and five years later it was still visible in the vitreous cavity. The patient was wearing an aphakic contact lens with a best corrected visual acuity of 20/30 OS.
Presented at the Third u.s. Intraocular Lens Symposium, Los Angeles, CA, March 25, 1980. Reprint requests to Dr. Dyson, 311 Central Ave., Suite 103, London, Canada N6B 2E1.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980
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
sents a new bicurved generation of the currently available super sharp suturing needles. The first or functional1.5-mm curve at the needle tip has a short radius for placement of the tissue bite. The second or carrier curve is the conventional long radius curve throughout the body of the needle which facilitates its manufacture, suture mounting and handling. The bicurved needle is used with a technique distinctly different from that used with the conventional needles. The needle holder must be rolled in an exaggerated motion between thumb and fingers rather than with minimal wrist movement. The tissue is entered without forceps eversion as the needle tip points directly downwards (Fig. 2). The full rolling motion of the needle holder causes the functional curve to arc through both sides of the wound. Forceps are used only for backup as the needle emerges from the proximal side. As the carrier curve passes through the tissue the wound's surface gapes harmlessly, falling back together as the needle completes its passage.
There is one significant inconvenience of the fish hook needle: it acts very much like a grappling hook and cannot be dragged by its suture across anything without snagging everything it passes and possibly causing the suture to break. This hazard may be avoided by picking up the needle.
SUMMARY The bicurved fish hook needle allows placement of consistently short bites to close cataract, keratoplasty or traumatic corneal wounds with minimal tissue compression and astigmatism. The technique of handling is different than that for traditional single-radius needles, however it is easily learned. This bicurved needle should find wide application in other microsurgical procedures, such as vascular anastomosis, tuboplasty and vasovasostomy.
II
/
Fig. 2 (Mcintyre). Top left: The fish hook needle begins its passage with its tip perpendicular to the tissue. Top right: The straight, locking needle holder is rolled to follow the arc of the functional curve. Bottom right: The needle holder continues to follow the short radius arc and the distal wound lip everts as the needle tip passes up through proximal tissue. Bottom left: As the fish hook needle is extracted, passage of the carrier curve causes wound eversion. AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980
283
ACKNOWLEDCE~ENT
Trese Rand and John Bergstrom provided the illustrations.
REFERENCES 1. Heller MD, Irvine SR, Straatsma BR et al: Wound healing aft-
er cataract extraction and position of the vitreous in aphakic eyes as studied postmortem. Trans Am Ophthalmol Soc 69:245, 1971 Troutman RC: Microsurgical control of corneal astigmatism in cataract and keratoplasty. Trans Am Acad Ophthalmol OtolaryngoI77:563, 1973 Jervey ED: Clear corneal section and cataract extraction. Southern Med ] 69: 170, 1976 Floyd C: Changes in the corneal curvature following cataract extraction. Am] Ophthalmol 34: 1525, 1951 Jaffe NS, Clayman HM: The pathophysiology of corneal astigmatism after cataract extraction. Trans Am Acad Ophthalmol Otolaryngol 79:615, 1975 Luntz MH, Livingston DC: Astigmatism in cataract surgery. BrJ Ophthalmol 61:360, 1977 Troutman RC: Microsurgery of the Anterior Segment of the Eye. St Louis, CV Mosby Co, 1974 Cravy TV: Calculation of the change in corneal astigmatism following cataract extraction. Ophthalmic Surg 10:38, 1979 White JH, Stern RU: A theoretical consideration of suturing technique. Ann Ophthalmol 3:509, 1971
2. 3. 4. 5. 6. 7. 8. 9.
has an outer cutting sleeve which passes over a side port (Fig. 2). The inner lumen of the instrument is connected to siliconized elastic (Silastic) aspiration tubing. The cutting mechanism is activated by light squeeze/release of the spring handle. Replacement fluid inflow can be coaxial (not shown) or through separate entry.
Fig. 2 (Simcoe). Side port for aspiration of vitreous.
anterior segment vitrectomy apparatus C. William Simcoe, M.D. Tulsa, Oklahoma A need exists for a simple, reliable manually operated autoclavable anterior segment vitrectomy apparatus. The vitrectomy instrument* shown in Fig. 1
retrieval and replacement of an iris plane implant dislocated five years previously into the vitreous cavity Charles Dyson, M.D. London, Canada CASE REPORT A 57-year-old railway crane operator examined in
Fig. 1 (Simcoe). Anterior segment vitrectomy apparatus.
*Availablefrom Storz Instrument Company, St. Louis, Missouri Reprint requests to Dr. Simcoe, Utica Square Medical Center, Suite 110, Tulsa, OK 74114. 284
December 1978 had a cataract OD which reduced vision in that eye to hand motion. Five years previously, this man had undergone intracapsular cataract surgery and primary implantation of an iris plane (Copeland) lens in the left eye. Postoperative examination showed that the lens had dislocated into the vitreous. No attempt was made to reposition the lens at that time, and five years later it was still visible in the vitreous cavity. The patient was wearing an aphakic contact lens with a best corrected visual acuity of 20/30 OS.
Presented at the Third u.s. Intraocular Lens Symposium, Los Angeles, CA, March 25, 1980. Reprint requests to Dr. Dyson, 311 Central Ave., Suite 103, London, Canada N6B 2E1.
AM INTRA-OCULAR IMPLANT SOC J-VOL. 6, JULY 1980