Ophthalmic surgical instruments by Dr. Iddi.pptx

Ophthalmic surgical instruments

1. Ophthalmic surgical instruments Presenter: dr. iddi ndyabawe Mmed ophthalmology Makerere university May 2021

2. WIRE SPECULUM Use: To keep lids apart during intraocular surgeries Lieberman’s wire speculum

3. Chalazion clump Uses: To fix the chalazion and achieve hemostasis during incision and curettage

4. Chalazion scoop It has a small cup with sharp margins attached to a narrow handle Uses: To scoop out content of chalazion during incision and curettage

5. Ptosis clump J shaped Use: To hold levator palpebrae superioris muscle during ptosis surgery

6. Punctum dilator ( Nettleship’s ) It has a cylindrical corrugated metal handle with a conical pointed tip Uses: To dilate the punctum and canaliculus during syringing, probing, dacryocystography , DCT and DCR procedures

7. Lacrimal probe (bowman’s) These are a set of straight metal wires of varying thickness (size 0-8) with blunt rounded ends and flattened central platform Uses: -To probe nasolacrimal duct in congenital blockage -To identify the lacrimal sac during DCT and DCR operations

8. Muscle hook Use: To engage the Extraocular muscles during surgery for squint, enucleation and retinal detachment

9. Enucleation spoon (optic nerve guide It’s a spoon shaped instrument with a central cleavage Use: To engage the optic nerve during enucleation .

10. Enucleation scissors They are large, stout and strong scissors having curved sharp blades with blunt ends. Uses : They are used to cut the optic nerve during enucleation operation

11. Evisceration curette (scoop) It consists of an oval or round shallow cup with blunt margins attached to a stout handle. Use: To curette out the intraocular contents during evisceration process

12. Evisceration spatula ( kimura ) Use: For removal of intraocular contents during evisceration Limitation : Inadequate removal of intraocular content

13. Bone punch Use: To enlarge the bony opening during DCR operation by punching the bone from margins of the opening

14. Kelman -McPherson forceps These are fine forceps with bent limbs. Uses : ( i )To hold the superior haptic of IOL during its placement. ( ii) To tear off the anterior capsular flap in ECCE. ( iii) Can be used for suture tying

15. Superior rectus holding forceps It is a toothed forceps (1 × 2 teeth) with S-shaped double curve near the tip. Uses : It is used to hold the superior rectus muscle while passing a bridle suture under it; to stabilize the eyeball during any operation such as cataract surgery, glaucoma surgery, corneal surgery, etc .

16. Colibri forceps Uses: These are used to hold the cornea or scleral edge (of incision) for suturing during cataract, glaucoma, repair of corneal and/or scleral tears and keratoplasty operations.

17. Westcott’s scissors Identification: They are stout scissors available with straight or curved blades with sharp or blunt tips. Uses 1 ) For cutting and undermining conjunctiva in various ophthalmic surgeries. 2) Can also be used instead of corneal scissors for creating limbal sections.

18. Corneal scissors ( Castravejo scissors ) Identification -They are fine curved scissors. Their cutting blades are kept apart by spring action. They are available in various shapes and sizes. Blades are angulated to facilitate manipulation and are curved to conform to the curve of limbus . Uses 1. To enlarge corneal or corneoscleral incision for cataract and keratoplasty operation 2. To cut the scleral or trabecular tissue in trabeculectomy

19. Crescent knife Blunt tipped beveled-up knife having cut-splitting action at the tip and both the sides Uses: To make tunnel incision on the sclera during MSICS, Phacoemulsification, and sutureless trab

20. Keratome knife Diamond shaped blade with a sharp apex and two cutting edges Uses: - Vulvular corneal incisions for entry into anterior chamber for all modern cataract extraction -self-sealing incisions for phacoemulsification and MSICS

21. SIDE PORT ENTRY BLADE Straight knife with sharp pointed tip and cutting on one edge Use: To make a small valvular clear corneal incision (commonly known as side port) in MSICS and phacoemulsification

22. Cystitome or Capsulotome Disposable cystitome is prepared by double bending the disposable 26 gauge or 30 gauge needles. One bend is at base and other at the tip of the needle . Uses: It is used for doing anterior capsulotomy or capsulorhexis during cataract surgery.

23. Iol dialer ( sinsky’s hook) Uses: To dial the PMMA non foldable IOL for proper positioning in the capsular bag or ciliary sulcus It can also be used to manipulate the nucleus during nucleus delivery in MSCIS

24. Hydro cannula Uses: To hydrate side-ports and ACM entries on completion of intraocular surgeries For hydro-dissection and hydro-delineation

25. Wire vectis Uses: To remove the subluxated / dislocated lens To deliver the nucleus in SICS/ECCE Ensure good papillary dilatation before introducing vectis Go b/w the lens and the PC and beyond the lens edge Be careful not to catch the pupil margin Lift up the lens and then withdraw

26. Castraveijo’s Caliper Uses : To measure the diameter of cornea, as in buphthalmos , micro/ megalocornea , etc. In various surgeries: SICS/PE: length of the incision Trabeculectomy : length of the scleral flap Squint: the amount of recession/resection of muscle Keratoplasty : occasionally used to determine the size of donor and recipient button RD surgery: to measure the distance for passing encircling band and to make ports at pars plana Ptosis surgery: measure the amount of LPS resected To measure the dimensions of a biopsy specimen

27. Baraquer's needle holder It has a smooth jaw which is curved as well as straight. It does not have a locking handle . Advantage: Good balance and lightweight. It offers desired strength and stability. Uses: For holding fine needles for 8-0 and 10-0 sutures May be used for preparing cystitome if Kaltz needle holder is not available

28. Kaltz Needle holder Description: Special pointed ends of Kaltz needle holder help in providing for a better grip of needles with locking handle. The overall length is 140 mm Uses: Used in ophthalmic surgery for holding needles, to suture relatively larger structures like lids and superior rectus . Also is used to prepare cystitome with 23 gauge needle

29. Iris Repositor : Uses: To reposit the iris in intraocular surgeries To perform synechiolysis To fashion the conjunctiva to cover the wound To check the size and location of anterior chamber entry To check for vitreous in the anterior chamber To push the foldable IOL into the bag after delivery from the injector.

30. Simcoe's irrigation- aspiration cannula Use : Aspiration of the cortical matter and Visco during MSICS

31. references http:// www.eophtha.com/posts/instruments-used-in-cataract-surgery-ready-reckoner-for-the-post-graduates Comprehensive Ophthalmology by Khuranah Video on Ophthalmic Instruments by Dr. Bhatia: https:// www.youtube.com/watch?v=20zrc8JlTBU&list=PL6avnbChzuQI84JThv5GEutU-L9Wr_1U1