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Objective: We tested the hypothesis that the ophthalmology microscalpel, compared to standard incisional instruments, causes less trauma during incisions resulting in decreased inflammation and greater tensile strength of wounds., Study Design: Prospective animal study., Setting: Animal laboratory., Subjects and Methods: Thirty-four Sprague-Dawley rats received dorsum skin incisions with the microscalpel, electrosurgical device, 11 blade scalpel, and 15 blade scalpel. Wounds were harvested at 1 week, 2 weeks, 3 weeks, and 6 weeks, then analyzed histologically in a blinded manner for inflammation markers and tested for tensile strength., Results: The microscalpel wounds had significantly higher tensile strength compared to the 15 blade (P = .045) and electrocautery device (P = .000) but equivocal strength to the 11 blade (P = .457). The electrocautery wounds were weaker than all 3 steel blades. No significant difference was found between the microscalpel, 11 blade, and 15 blade incisions for the 5 markers of inflammation. Electrocautery wounds had significantly worse inflammatory scores, specifically, higher angiogenesis and larger wound gap compared to the microscalpel (P = .004, P = .002), 11 blade (P = .007, P = .023), and 15 blade (P = .010, P = .003), respectively., Conclusion: Microscalpel incisions result in less inflammation and increased tensile strength compared with electrocautery and higher tensile strength compared to the 15 blade in the rat model. Inflammation scores were equivocal between the microscalpel, 11 blade, and 15 blade. Our findings support the use of the microscalpel blade for facial plastic and reconstructive procedures. Prospective, randomized human studies are warranted., (© American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.)

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.

Background and Objective: To describe a suction-based grasping tool for the surgical removal of irregular-shaped and nonferromagnetic intraocular foreign bodies., Materials and Methods: A surgical tool with suction capabilities, consisting of a stainless steel shaft with a plastic handle and a customizable and interchangeable suction tip, was designed in order to better engage and manipulate irregular-shaped in-traocular foreign bodies of various sizes and physical properties. The maximal suction force and surgical capabilities were assessed in the laboratory and on a cadaveric eye vitrectomy model., Results: The suction force of the water-tight seal between the intraocular foreign body and the suction tip was estimated to be approximately 40 MN. During an open-sky vitrectomy in a porcine model, the device was successful in engaging and firmly securing foreign bodies of different sizes and shapes., Conclusion: The suction-based grasping tool enables removal of irregular-shaped and nonferromagnetic foreign bodies., (Copyright 2013, SLACK Incorporated.)

The H2O2-low-temperature-plasma-sterilization (STERRAD 100) works with a temperature below 50 degrees C (140 degrees F). This system is appliable for thermostabile materials as well as for thermolabile materials. The efficancy of this new system is shown by a biological test with Bacillus pumilus spores. 5 typical ophthalmic surgical instruments were contaminated. After sterilization the numerical reduction of the microorganisms had to be at least 6 log levels. Corrosion caused by hydrogene peroxide was excluded after exposing steal with a high quantity of this substrate. Electromicroscopy analysations of the surfaces of stainless steal after LTP, steam sterilization and hot-air sterilization are compared. Options and limitations of this new sterilization technique are discussed. A newly developed operating system with a complete instrumental box (OP-Set) will be introduced.

Acetone has been considered a quick, effective and less expensive chemical sterilising agent and continues to be used by ophthalmic surgeons, at least in developing countries. Its utility however has been questioned recently. This study was designed to assess the efficacy of acetone against Pseudomonas aeruginosa, Bacillus subtilis and Aspergillus flavus present on ophthalmic surgical instruments (forceps, sutures). The instruments were contaminated by immersion in standard suspensions of the organisms and thereafter were either unwashed (group-I), washed and dried (group-II) or only washed (group-III) before immersion in acetone. The exposure to acetone was kept at 3, 10 and 20 minutes in each group. The results showed that acetone could eliminate Pseudomonas (vegetative bacteria) after 10 minutes exposure in unwashed group and 3 minutes exposure in washed groups. It was ineffective against spore bearing bacteria (B. subtilis) and fungus (Aspergillus flavus) even after 20 minutes of exposure.

Illumination sometimes becomes a problem during ophthalmic surgery, especially in retroequatorial myopexia (Fadenoperation). The common headlights use to reduce the mobility of the surgeon. We present a modified SAUTTER's orbita spatula, which is armed with a fibre-optic. It can be connected with a commonly available cold-light-source. The prototype can been used in the following surgical procedures, retroequatorial myopexia (Fadenoperation) demonstrated by photograph: tendon tucking of the superior oblique, retinal detachment surgery, orbital tumors. Several surgeons regarded the optimal illumination of a difficult surgical situs as an improvement. With some modifications of the prototype which are prepared now the illuminated orbital spatula should become a useful instrument for the ophthalmic surgeon.

Accidental needle puncture of the skin carries the risk of transmitting infection. Accidental needle-stick injuries comprise one third of work-related accidents. A capping device was devised to protect medical personnel during handling of sharp instruments.

To meet the need for both scientific information and a clinical means for measurement of the mechanical parameters of the most difficult individual strabismus cases we present a technique for directly measuring and plotting the length-tension characteristics of the tissues supporting the eye. Semiconductor strain gauges mounted on the shanks of a custom machined eye forceps and an ultrasonic method of making continuous duction measurements of the eye have proved feasible. When the forceps are interfaced with a dedicated microcomputer, the system provides a permanent, quantitative, length-tension record displayed in real-time. The instrumented length-tension forceps system has provided a noninvasive means for quickly and simply assessing the mechanical underlying determinants of strabismus pathology in the office, the laboratory or in the operating room, and can aid in the planning and immediate intraoperative alteration of strabismus surgery. Under operator coordination, measurements can be made which precisely define the mechanical load which the eye muscles must move. The resulting objectively determined tissue stiffness asymmetries and muscle restrictions limiting ocular motion indicate the purely mechanical contributions to a patient's strabismus. Measurements of active force indicate the magnitudes and patterns of innervation over the entire range of gaze. By comparison of these active force and passive stiffness records, nerve signal imbalances may be quantitatively distinguished from mechanical imbalances in strabismus. It is the detailed interaction of these nonlinear muscle forces and mechanical elements which determines the position of each eye in strabismus and therefore the proper surgical treatment. A brief description of actual use and a few examples of clinical results are included from over 200 human records.

A new minitrephine, with a stainless steel tube of 0.81-mm outer diameter, 16-mm length, a plastic hub and handle assembly for manual rotation, Luer lock attachment to either standard or specially designed 3-ml syringe with spring-assisted plunger, and an intraluminal stylet--all disposable--has been designed by us principally for opening a distally occluded lacrimal canaliculus prior to stenting with any desired implant. Local anesthesia via a nasociliary nerve block makes this an office procedure. Other potential uses include transscleral globe biopsies of suspected malignancies, intraorbital biopsies, drainage of fluid-filled spaces wherein a beveled needle evacuation might undesirably pierce the far end of the cyst--all with possible ultrasonic monitoring--or the creation of a correctly sized, round, noncollapsible passage for a Molteno valve stenting of the anterior chamber, for intractable glaucoma.

We describe our technique for the surgical removal of hyphema using the Ocutome vitrectomy system and report the results in 12 patients. Blood was removed successfully with just one operation in all 12 eyes. Eleven of the 12 eyes maintained intraocular tension of less than 20 mm Hg. Vision improved in 11 of 12 eyes and six had a vision of 6/18 or better. Permanent vision loss could not be attributed to the operative technique.

A lens holder for posterior segment vitrectomy is described. Its advantages are: better centering, optional use during surgery, simple handling and optimal exploitation of the prismatic effect for a better view into the periphery.

The development of the single point cam guided cornea trephine frees the cornea surgeon from always cutting a round recipient window perpendicular to the visual axis of the eye. This new trephine allows for any angle of cut relative to the visual axis of the eye and any shaped window, be that window round, ellipse, oval or "other than round." Full development of the technique lies in the future with the development of more complete topographical measuring techniques and the integration of the measurement into a computer program wherein the computer controls the indexing of the blade cutting the recipient window and the angle of the blade while the blade is making the incision.

To faciliate drainage of subretinal fluid I modified cross-action forceps so that the 10-mm angulated tip had eight semicircular opposed teeth each 1 mm long.

We used the retinal cryoprobe in the surgical management (biopsy and excision) of orbital and ocular adnexal tumors in four patients. The strong bond between the cryoprobe tip and the tumor allowed application of moderate traction to the tumors, facilitating their removal. The amount of traction on the tumor or cyst appeared to be much greater than that caused by forceps or clamps. In one case, however, marked traction with the cryoprobe caused rupture of the tumor capsule. In another case, in which a cyst wall was entered during dissection, we applied the cryoprobe to the opening, sealing the hole with an ice ball, to keep the cyst from collapsing. Histopathologic structure was not altered by cryoprobe applications.

We report on the construction and the function of a new microsurgical instrument for vitrectomy. The instrument is introduced into the vitreous cavity through a small scleral incision in the pars plana area. Microscope observation with slit-lamp illumination and a specially designed contact lens are used for this surgical procedure. Our clinical experiences and the indications are discussed.

A double-edged cutting blade oscillates between a clockwise and a counter-clockwise high speed rotation without completing a full revolution. This imparts a great mechanicaldvantage and safety to the instrument's cutting efficiency. The cutter may also be used with a continuous high speed clockwise rotation. Multiple interchangeable probe tips are used that are of either double- or triple-walled construction. A fiber-optic light pipe surrounds the probe tip used for deep vitrectomy in conjunction with an irrigated fundus lens. A film will illustrate the use of the roto-extractor in two diabetic patients with old unabsorbed vitreous hemorrhage and membranes. In the first case, a pars plana incision was used for vitrectomy in conjunction with a cataract extraction. In the second case, the para plana vitrectomy was combined with an optical iridectomy necessitated by the presence of an updrawn pupil following previous cataract extraction complicated by vitreous loss. To date, 12 roto-extractors have been distributed to 12 various teaching institutions throughout the United States.

Description of Grieshaber nibbler for closed vitreous surgery: tip diameter is 1.6 mm, cutting is by four exquisitely cutting blades mounted on axis supported at both ends. Control console determines mode and speed of rotation. Oscillating cutting mode is recommended. Infusion is at the instrument's tip instead of its side. Unusually powerful but adjustable endo-illumination is available through fiberoptics. The fiberoptics tip is shaped to facilitate its introduction into the eye. A separate channel permits suction reversal. Five brief case descriptions illustrate versatility of the instrument. Its main advantages are its exquisite cutting properties, its powerful and adjustable endo-illumination, and its tip-end infusion hole.

An improved retinal tack and applicator can be used to fix the retina to the wall of the eye mechanically. The system consists of a small (1 X 2.7 mm) stainless steel tack with a blade-like tip and a forked applicator that can grasp the tack securely from any position. Two eyes with complex detachments with fixed rolled retinas could not have been repaired without the help of retinal tacks. The advantages of the retinal tack system over other methods include ease of handling, insertion, and removal.

Vitreous scissors with bent blades and forceps of larger than usual dimension were developed for removal of inflexible membranes and intraocular foreign bodies.

I have devised a superior rectus fixation forcep of heavy construction which can be used with ease in the field of the operating microscope.

Mechanical fixation of the torn or cut edge of retina with 30-gauge hypodermic stainless steel tacks has been performed in 15 patients at the Bascom Palmer Eye Institute, Miami, and Miami Veterans Administration Medical Center with six to 18 months of follow-up. The companion tack inserter allows the surgeon to select an angle for the shaft of the tack in relation to the inserter to allow the tack to be driven perpendicularly into sclera even when the insertion is anterior to the equator. If residual detachment remains following fluid-gas exchange after preliminary placement of the retinal tacks, a given tack may be removed and reinserted to facilitate complete retinal reattachment. This utilitarian feature allows the surgeon to eliminate residual anteroposterior traction following complete membrane peeling by extending relaxing retinotomies and tacking the posterior cut edge of the retina securely between the ora serrata and the equator.