Ophthalmology INSTRUMENtS 2 [Autosaved]-1.pptx

Ophthal instruments

1. INSTRUMENTS.

2. Barraqer Wire speculum/Universal eye speculum. Universal speculum consist of 2 non adjustable limbs joined to one end and opened at the other end. It is called as universal speculum because it is used for both the eyes and both intra ocular and extra occular surgeries.

3. Examination of patients with blepharospasm. Slit lamp procedures like :- Examination of uncorperative patients or patients with altered sensorium Removal of corneal foreign body. Uses :- Intraocular surgeries like :- Cataract surgery,glaucoma filtration surgery. Extraocular surgeries like :- Pterigium surgery,squint surgery,Oculuplastic surgery (enucleation/evisceration).

4. Speciality of Wire speculum:I t doesn’t provide much pressure on the globe So it is used in the intra ocular surgeries

5. Superior rectus forceps.

6. Superior Rectus Forceps :- It consists of grooved handle S shaped curve double curve 1x2 tooth Uses :- Hold the superior rectus tendon while passing birdle suture beneath it during cataract surgery. To stabilize the eyeball during any surgery eg –cataract surgery, pterygium excision. Complications: superior rectus muscle damage.

7. IOL DIALER/SINSKEY’S HOOK.

8. IOL DIALER/SINSKEY’S HOOK. Pencil like handle with an angled,blunt 0.18-0.2mm tip Uses :- It is used to dial the iol into the capsular bag or ciliary sulcus. Rotation of nucleus and prolapsing in to the anterior chamber Lens dialing and manipulation

9. Epilation forceps.

10. Epilation forceps. These forceps have short and stout handles with a round to oval-shaped tips . Both inner surfaces have flat platforms for firm grip or hold of an eyelash base. The Barraquer cilia forceps has long, tapered, and angulated tips toprovide a better view of the trichiasis eyelashes. Uses :- To perform manual epilation in patients with trichiasis/distichiasis. To remove the eyelashes during electrolysis procedure. It can also be used as an adjunct to handle sutures while tying or removing.

11. Nettleship Punctum dilator

12. Nettleship Punctum dilator All these dilators are long and slender with tapering pointed tips, availablein different sizes of 0.2, 0.3, and 0.4 mm tip diameter, and annular or diamondknurling for facilitating the torsion force leading to rotatory movement s during mechanical punctum dilatation process Uses :- Diagnostic—before performing any lacrimal irrigation ± probing for the diagnosisof the site of obstruction, it should be mandatory to dilate all the punctum. Therapeutic—to mechanically dilate a stenosed punctum as the first line of treatment for mild punctal stenosis. To dilate the lacrimal punctum while performing punctoplasty , canaliculoplasty,and nasolacrimal duct probing for congenital nasolacrimal duct obstruction

13. Chalazion curette

14. Meyerhoefe Chalazion curette This is a delicate instrument with a long shaft and a small curette at the tip of its business end. The edges of the round cup-shaped curette are generally sharp, and it may be available in various diameters (1–3.5 mm). The Skeele curette has typical serrated edges which might prove traumatic to the surrounding tissues of tarsal plate, hence less commonly used. Uses To curette out the lipo-granulomatous material from chalazion. To remove any impacted foreign body over the tarsal plate. Larger (3.5 mm) curette can be used to remove residual focal uveal tissue during an evisceration.

15. Side port entry blade

16. Side port entry blade. It is fine straight knife with sharp pointed tip and cutting edge on one side. Use: It is used to make a small valvular clear corneal incision (commonly called as side port incision) in phacoemulsification and other intraocular surgeries including pars plana vitrectomy. Also known as 15 degree blade.

17. KERATOME.

18. Keratome . It is a thin diamond shaped blade with sharp apex and two cutting edges. Use: Keratomes are used to make valvular corneal incisions for entry into the anterior chamber for all modern techniques of cataract extraction viz. phacoemulsification , SICS and even conventional ECCE and other intraocular surgeries, e.g. itidectomies and paracentesis .

19. Cystotome It is a small needle knife with bent tip which is sharp on both the edges. Use: It is used for doing anterior capsulotomy or capsulorhexis during extracapsular cataract extraction.

20. Corneal scissors.

21. Corneal scissors. These are fine curved scissors cutting blades are kept apart by spring action. used to enlarge corneal or corneoscleral incision for conventional intra capsular and extracapsular cataract extraction techniques (sparingly performed procedures nowadays) of cataract surgery. To enlarge corneal incision in keratoplasty operation. To cut the scleral an d trabecular tissue in trabeculectomy. It can also be used for cutting and undermining conjunctiva in various operations.

22. IOL HOLDING FORECEPS.

23. IOL holding forceps. It is a spring action forceps with short and blunt curved blades having smooth edges and tips with no serrations and teeth. Use:To hold optic of non-foldable PMMA IOL during implantation.

24. Chalazion clamp.

25. Chalazion clamp. Chalazion clamp has two circular blades one of which is open. It has a screw, which can be tightened. It is used for incision and curettage of chalazion . Solid blade is placed on the skin side and the open side is placed on the conjunctival side and the screw is tightened to hold the lid and to stablize the mass to achieve hemostasis. To excise the small conjunctival mass

26. Mucoperiosteal elevator.

27. Mucoperiosteal elevator. This is a double ended instrument typically has round handle with two slightly curved tear drops tips.

28. Mucoperiosteal elevator. Uses; Used to elevate the periosteum off the maxillary bone in DCR surgery. It can be used to reflect the lacrimal sac laterally along with periosteum from lacrimal sac fossa. It can be used to create the first opening through the bony suture of lacrimal sac fossa. To lift periosteum in orbital exenteration and orbital wall fracture repairs. To lift the nasal mucoperiosteum during endonasal DCR. It can be used to do blunt dissection around the soft tissue masses/tumors while doing excisional biopsy or orbitotomy . It can be used as a blunt soft tissue retractor in small incision surgeries.

29. Knapp’s or Rollet “Cat’s Paw” Retractor

30. It is a fork like an instrument with the terminal bent involved.

31. Knapp’s or Rollet “Cat’s Paw” Retractor. Uses To retract the skin, muscle, and periosteum in external DCR procedure To retract soft tissue in an orbitotomy , routine ophthalmic plastic surgery procedure To retract the tough contracted scar tissue in case of skin grafting to temporarily compress a bleeder vessel in the soft tissue during a DCR To retract and lift the soft tissue simultaneously, during any surgery (firm grip) To retract skin and muscle while harvesting fascia lata from thigh region for frontalis sling surgery.

32. Kerrison’s / Citelli’s Bone Rongeur or Punch/Bone Rongeur .

33. It consists of stout spring handle and 2 blades attached at right angle the upper blade has small hole with sharp cutting edges and lower blade has cup like depression.

34. Kerrison’s / Citelli’s Bone Rongeur or Punch/Bone Rongeur . Used to create and enlarge a bony ostium (Nasal bone) in cases of dacryocystorhinostomy (DCR). ideal size of the bone is excised -15mm It can be used to punch out the irregular bone in old displaced orbital fractures. It can be used to enlarge the bony opening to remove the muscle from floor fracture, frontal bone reduction in orbital decompression, etc. Used to punch the overhanging orbital rim for better access to the lateral/superior tumors and during the initiation of keyhole osteotomy. It can be used to take a biopsy in bone tumors.

35. Wells Enucleation Spoon/optic nerve guide

36. Wells Enucleation Spoon/optic nerve guide Spoon shaped instrument with central cleavage. Absolute indications: To perform enucleation in advanced malignant intraocular tumors like retinoblastoma, uveal melanoma. Relative indications To perform enucleation while harvesting an eyeball during an “eye donation” To enucleate an eye with phthisis bulbi for cosmetic rehabilitation (post traumatic, congenital partial anophthalmia ). To perform therapeutic enucleation for painful blind eyes.

37. Containdications of enucleation:  Intraocular malignancy with evidence of orbital spread

38. Metzenbaum or Storz Enucleation Scissors

39. Metzenbaum or Storz Enucleation Scissors. They are large and stout strong scissors having curved sharp blade with blunt ends. Used primarily to perform cutting of optic nerve during an enucleation . Can be used to carry out blunt dissection around orbital mass lesions. Can be used to perform full-thickness eyelid incisions or lateral canthotomy in emergency situations. Can be used to cut thick cotton/gauze pieces, thin drain pipes, etc. Can be used to perform tenotomy if appropriate scissors are not available.

40. Mule and Bunge Evisceration Scoop.

41. Also known as evisceration curette. It consists of an oval and rounded shallow cup with blunt margins attached to handle. To scoop out the majority of uveal tissue and other intraocular contents during an evisceration. To scrape off the residual uveal tissue from the posterior inner scleral surface. To perform blunt dissection around orbital masses To scoop out well-defined orbital lesion/masses Can be used a soft tissue retractor in orbitotomy procedures Can be used a platform/guard to fashion small eyelid, canthal incisions. Mule and Bunge Evisceration Scoop.

42. Desmarres Eyelid Retractor

43. Desmarres Eyelid Retractor. Saddle shaped instrument folded on itself at one end. To perform retraction of the eyelid skin, muscles, and superficial fat while per-forming eyelid or superficial orbital surgeries To open single or both eyelids of an uncooperative patient for basic ocular evaluation (eyelid or facial burns, spasm due to foreign body, etc.) To perform “double eyelid eversion” for detecting any foreign body in superior fornix/washing of chemical deposits in ocular chemical injuries Can be used to insert or remove an ocular prosthesis or contact lens in uncooperative patients To perform eyelid retraction of both eyelids during short surgical procedures For ocular inspection of a patient with severe blepharospasm

44. Berke’s Ptosis Clamp

45. Berke’s Ptosis Clamp. It is a forceps with j shaped ends having internal serrations. To hold the LPS aponeurosis for better anterior and posterior dissection/manipulation during LPS resection surgery. It can be used for isolating LPS from other tissues during an anterior orbitotomy. Can be used in LPS resection, LPS advancement, and LPS disinsertion repair surgeries. Rarely, can be used to hold a rectus muscle while operating over or around it.

46. BARD PARKER HANDLE.

47. BARD PARKER HANDLE. Bard-Parker's handle named after Charles Russel Bard and Morgan Parker, this handle is available indifferent sizes. Also known as BP handle, it is light and affords a firm grip. Blade of different sizes can be fitted onto a groove at the tip of the handle for making the desired incision.

48. WIRE VECTIS.

49. WIRE VECTIS. It is wire loop attached to a metallic handle. USES : it is used to remove dislocated or subluxated lens and nucleus in ECCE.

50. UTRATA CAPSULORHEXIS FORECEPS.

51. UTRATA CAPSULORHEXIS FORECEPS. It is fine tipped delicate forceps with small curved tips to hold the anterior lens capsule during continuous curvilinear capsulorhexis,while avoiding damage to the other structures.

52. SIMCOE CANNULA/ IRRIGATION ASPIRATION CANNULA

53. SIMCOE CANNULA/ IRRIGATION ASPIRATION CANNULA It has two openings, one on tip of cannula for irrigation and one on anterior surface for aspiration of lens matter or other contents. At its posterior end, there is one hub anterior to that of hypodermic needle for attachment to IV line for irrigation. At the other side, there is a cannula with a plastic tubing and another hub for attachment to a syringe or other source of vacuum for aspiration. Uses: ( i ) For irrigation and aspiration of the lens matter in extracapsular cataract extraction. (ii) Aspiration of  hyphaema .

54. COLIBRI FORECEPS.

55. COLIBRI FORECEPS. These are forceps with very fine teeth at the tip USE: These are used to hold cornea or scleral edge for suturing during cataract ,glaucoma, repair of corneal and scleral tears and keratoplasty operations.

56. BOWMAN PROBE.

57. BOWMAN PROBE. These are set of straight metal wires of varying thickness with blunt rounded ends and flattened central platform. • To perform probing of nasolacrimal duct (NLD) in CNLDO. • To identify and localize the distance of canalicular obstruction. • To diagnose and treat lacrimal canalicular stenosis. • To “tent-up” the medial lacrimal sac mucosa for fashioning lacrimal sac flaps in External and endoscopic dacryocystorhinostomy (DCR) surgery. • To do a lacrimal canalicular assessment in cases of canalicular lacerations. • To prevent and identify an inadvertent injury to canaliculus while operating in its vicinity (e.g., medial diamond conjunctivoplasty for punctum ectropion).

58. IRIS REPOSITER.

59. IRIS REPOSITER. It consists of a delicate, flat, malleable, straight or bent blade with blunt edges and tip attached to a handle. Uses: i ) To reposit the iris in the anterior chamber in any intraocular surgery. Ii ) To break synechiae at the pupillary margin.

60. 24 G canula

61. 26 G canula

62. INTRAOCULAR LENS

63. INTRA OCULAR LENS The commonly used material for their manufacture is polymethylmethacrylate (PMMA). Depending upon the method of fixation in the eye,major classes of IOLs are., 1) ANTERIOR CHAMBER IOL, 2) IRIS SUPPORTED IOL, 3) POSTERIOR CHAMBER IOL.

64. Anterior chamber IOL. These lenses lie entirelyin front of the iris and are supported in the angle of anterior chamber. ACIOL can be inserted after ICCE or ECCE. These are not very popular due to comparatively higher incidence of bullous keratopathy. When indicated, ‘ Kelman multiflex ’ type of ACIOL is used commonly.

65. IRIS SUPPORTED LENS. Iris-supported lenses. These lenses are fixed onthe iris with the help of sutures, loops or claws.These lenses are also not very popular due to a high incidence of postoperative complications.Example of iris supported lens is Singh and Worst’siris claw lens. These lenses are fixed on the iris with the help of sutures, loops or claws. These lenses are also not very popular due to a high incidence of postoperative complications. Example of iris supported lens is Singh and Worst’s iris claw lens

66. PCIOLs rest entirely behind the iris . They may be supported by the ciliary sulcus or the capsular bag. Recent trend istowards ‘in-the-bag-fixation’. Commonly used model of PCIOLs is modified C-loop. Depending on the material of manufacturing, three types of PC-IOLs are available : i . Rigid IOLs. The modern one piece rigid IOLs are made entirely from PMMA. ii. Foldable IOLs, to be implanted through a small incision (3.2 mm) after phacoemulsification are made of silicone, acrylic, hydrogel and collamer . iii. Rollable IOLs are ultra thin IOLs. These are implanted through micro incision (1mm) after phakonit technique. These are made of hydrogel.

67. Based on the material of manufacturing 2 types of PCIOLs are available., 1) FOLDABLE IOL, 2) RIGID IOL.

68. RIGID IOL.,These are made entirely from POLYMYTHYL METHACRYLATE.(PMMA).

69. FOLDABLE IOL s, to be implanted through a small incision of (3.2 mm) after phacoemulsification are made of silicone, acrylic, hydrogel and collamer . Acrylic material is available in two form-hydrophilic and hydrophobic. At present, the best available material IOL is hydrophobic acrylic. Thinner foldable IOLs can be implanted through 2-2.2 mm incision. Foldable IOLs are implanted with the help of an IOL injector.Ultra -thin foldable IOLs, are implanted through 2 mm incision after microincision cataract surgery (MICS) technique. These are made of hydrogel.

70. SUTURE MATERIAL Both absorbable and non-absorbable sutures are used in ophthalmology. Non-absorbable sutures are preferred for corneal suturing, conjunctival suturing. Absorbable sutures are preferred in squint surgeries,dacryocystorhinostomy (DCR), scleral su t uring : Non-absorbable sutures: Nylon 10-0, 9-0 are preferred for corneal suturing Absorbable sutures: Vicryl 6-0 is used in squint surgeries, DCR.

71. TYPES OF SUTURE: 1) Absorbable suture.,