Search

Wet lab and surgical simulation can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and improve patient safety. To provide the most up-to-date information and hands-on experiences with novel ophthalmic surgical techniques and instruments, the Department of Ophthalmology at Western University has created a wet lab-based, multilevel microsurgery skills transfer course through collaboration with various industry partners. Several elements in the course goal and design differentiate this type of surgical course from typical wet labs: the format is multileveled surgical training, with a beginner level targeting undergraduate medical students, an intermediate level for ophthalmology residents, and an advanced level for trained ophthalmologist. In addition, the level of industry participation allows the development of true partnership and offers a method to introduce awareness and innovation in a cost-effective manner. This article presents the organization, course setup, and feedback from the pilot course., (Copyright © 2016 Canadian Ophthalmological Society. Published by Elsevier Inc. All rights reserved.)

The Food and Drug Administration (FDA or Agency) is classifying the scleral plug into class II (special controls), and exempting the scleral plugs composed of surgical grade stainless steel (with or without coating in gold, silver, or titanium) from premarket notification (510(k)) and continuing to require premarket notification (510(k)) for all other scleral plugs in order to provide a reasonable assurance of safety and effectiveness of the device. The scleral plug is a prescription device used to provide temporary closure of a scleral incision during an ophthalmic surgical procedure.

Purpose: To report a new, noncontact wide field viewing system for vitreoretinal surgery., Design: Device description: A noncontact wide field viewing system consisting of adjustable hinged arm and a combined condensing lens and reinverting prism has been developed. The arm clamps onto the operating table or wrist rest and holds the lens system in the air above the eye., Methods: For vitreoretinal surgery, a new, relatively inexpensive noncontact wide field viewing system consisting of an adjustable hinged arm and a combined condensing lens and reinverting prism has been developed. The combination condensing lens and reinverting prism is used without a microscope-mounted inverter. The optical component may be sterilized with ethylene oxide, peracetic acid, or glutaraldehyde. Other components may be steam autoclaved., Results: The new, noncontact wide field viewing system has been used satisfactorily in more than 200 vitrectomies at seven medical centers. It provides an excellent view of the vitreous and retina., Conclusion: A new, noncontact wide field viewing system for vitreoretinal surgery has been developed with satisfactory image quality and a field of view comparable to contemporary noncontact panoramic viewing systems.

A new type of knife that enables a surgeon to easily create tunnel-shaped incisions with a prescribed depth has been developed. The knife features an incision guide, the arm of which extends just beyond the tip of the blade. The space between the blade and the arm can be set at the desired width. By moving the knife as if sliding the arm across the corneal or scleral surface, the blade can move to a certain depth from the surface. The guided knife enables even novice surgeons to easily make a self-sealing incision during cataract surgery. In addition, the innovative nature of this device seems to be applicable to many other surgeries that require a partial-thickness incision.

Retained intraocular BBs are difficult to remove. According to manufacturers' specifications, BBs have a spherical diameter of 4.5 mm and a copper plate covering a steel core. They have only moderate magnetic properties because of the copper plate cover and they are too large to be grasped by almost all intraocular forceps and, therefore, present a problem when they are retained in the eye after injury. Arch Ophthalmol. 2000;118:1574-1575

Objective: To develop a reliable inexpensive device for teaching ocular surgical procedures and practicing experimental techniques on enucleated eyes., Design: Teaching device trial., Participants: Thirty enucleated porcine eyes., Methods: A Plexiglas ocular bulb holder was secured with its base support to a polyvinylchloride pillar on a modified polystyrene trial head., Main Outcome Measure: The convenience and reproducibility of both laser and surgical ocular techniques performed with this new device were evaluated., Results: This model allows curvilinear capsulorrhexis and phacoemulsification of porcine lenses through a corneal tunnel incision and insertion of a soft foldable acrylic intraocular lens into the capsular bag. Argon and neodymium:YAG laser iridotomy and retinal argon laser photocoagulation can also be performed with this model., Conclusions: This inexpensive device is useful for teaching both surgical and laser ocular procedures.

A new instrument fixing the sutured tissue without compressing, deforming, or displacing it has been developed. The needle runs between special lugs of the instrument simultaneously fixing the sutured tissue to their surface. Use of this fixing device in microsurgical treatment of perforating wounds, keratoplasty, and cataract extraction yielded good functional results.

Purpose: Evaluation of the safety of a laminar flow clean air hood for the sterile storage of ophthalmic instruments in an operating room., Methods: A ten-year retrospective study of 10,524 surgical procedures performed with instruments stored in a clean air hood was conducted at the Mayo Clinic. Cases of postoperative endophthalmitis were identified through review of the diagnostic indices maintained by the ophthalmology department and the institution and through review of individual patient records., Results: The incidence of endophthalmitis in surgical cases in which instruments stored in a clean air hood were used was 0.076% (eight of 10,524 cases). No clusters of infection were identified., Conclusions: The use of a laminar flow clean air hood provides access to surgical instruments in a high-volume operating room without exposing patients to an increased risk of endophthalmitis.

Plasma sterilization is a nontoxic fast procedure for thermolabile and thermostable microsurgical instruments. We report data on the microbicidal effectiveness for daily routine surgical instruments like steel scissors, trephination devices, microstripper and Vitro-Cat as well as irrigation/aspiration instruments. When these instruments were cleaned from blood and saline, and when H2O2 intensifiers (adapters) were applied where necessary plasma sterilization proved to be a microbiologically safe procedure with legally adequate reduction factors of > 6 log.

We describe an operating table in which the whole patient, apart from the eye undergoing surgery, is enclosed in a caisson within which the barometric pressure can be lowered at any time during surgery. This increases the effect of atmospheric pressure on the eye, enabling 'open sky' surgery to be carried out on patients of any age.

A simple regulator, used for flow rate control of intraocular irrigating fluids, can prevent hypotonia and result in cost saving.

We developed an automated diaphragm control to achieve constant good exposure during televised microsurgery by using a commercially available diaphragm control for a movie camera and modifying slightly the television camera.

This modified surgical drape support is affixed to the patient's nose and face with self-adhesive pads or sterile surgical tape. The disposable support is flexible and keeps the surgical drape away from the nasal and oral passageways, facilitating observation of the patient by operating room personnel and relieving the patient's anxiety and the breathing problems that often occur during ophthalmic procedures.

The prism-magnifier developed and constructed by Biessels has been used as a low-vision aid since 1971. It has been derived from the Carl Zeiss (W. Germany) 8 x 20 mini prism-binoculars. The system has several advantages. The prism-magnifier also enables the eye surgeon to perform microsurgery without the disadvantages of a stand-microscope.

A newly designed double-ended needle holder provides the surgeon who is operating on the anterior segment with the advantages of both a straight and curved needle holder without having to change instruments.

A new ophthalmological operating table is presented which is adapted to the most recent developments in microsurgery and for the treatment of the most difficult cases of vitreoretinal pathology. The head of the table is mobile in the sagittal plane, movements being effected under remote-control by the surgeon at a rate of 2 mm/sec. The same movement can be applied to a horseshoe shaped armrest, which is solidly attached around the headpiece and is adjustable for height. A respiratory shield can be attached during local anesthesia, and the table can be positioned in proclivity or declivity. During vitreoretinal surgery, the table enables rotation of the patient in ventral decubitus along a longitudinal axis, rotation being possible manually or electrically. Proclivity and declivity positions can be obtained by rotation on a transversal axis. These functions assist exchanges between ocular fluids and substances used for internal packing, as well as passage into the anterior chamber of foreign bodies in the vitreal cavity.

In some patients undergoing intraocular procedures, the intraocular pressure may remain dangerously high immediately before surgical penetration of the anterior chamber despite all available measures. A mechanical device, called an "Intraocular Pressure Reduction and Regulation System," has been devised as a means of reducing and regulating intraocular pressure immediately before and during intraocular procedures. The system has been used in selected glaucoma patients with satisfactory results.