Keep Connections With Colleagues on Your Radar
Spring is the season for conferences and live events, which can go a very long way toward revitalizing your outlook....
This website uses cookies. to enhance your browsing experience, serve personalized ads or content, and analyze our traffic. By clicking “Accept & Close”, you consent to our use of cookies. Read our Privacy Policy to learn more.
By: Wayne Bizer
Published: 4/3/2008
A whole new category of micro-ophthalmic instruments has arrived on the scene in the last several years to accommodate new phacoemulsification techniques and their smaller incisions. Two decades ago, a surgeon could have more than 20 instruments in his tray for cataract surgery. Today, most have fewer than a dozen, many of which, such as the Utrata forceps for tearing the capsulorhexis, have become smaller along with the phaco incision. Here's a review of the tools your surgeons pass through the 1mm side-port incision.
My, How Things Have Changed |
Things have changed a great deal since I performed my first cataract surgery in 1974. For starters, today's procedure is dramatically safer and less stressful for both the patient and surgeon. Phacoemulsification, in which the central nucleus is broken into tiny pieces by ultrasound and aspirated out of the eye, is the biggest change in the last three decades. Before phacoemulsification, which requires only a small incision, extracapsular cataract extraction (ECCE) was the most common method of removing cataracts. In ECCE, the whole hard nucleus is removed in one piece within its surrounding capsule or outer skin of the lens. This requires a large 8mm to 10mm incision and wound closure with sutures. Since phacoemulsification became widely adopted, incision sizes have become smaller and smaller, first to 3.2mm, then to 2.8mm. Some ophthalmologists perform surgery with two 1.2mm phaco incisions in the bimanual micro-incision phaco technique. But this technique requires widening the incision to accommodate the intraocular lens (IOL) and its insertion device. In Europe and Canada, lenses that will fit through a 1.8mm-incision are now on the market, but they've yet to be approved for use in the United States. Over the years, these smaller incisions have let surgeons perform sutureless cataract surgery, which has shortened the procedure time, contributed to shorter healing times and decreased post-surgical astigmatism. Still, developing IOLs that can be folded into smaller sizes is a constant challenge as the length of the phaco incision continues to decrease. — Wayne Bizer, DO, FAOCO |
Diamond blades cost a lot more than steel blades ($500 to $3,000 each), but I feel that they are worth it, as long as you take proper care of them. Many companies offer diamond blade repair services. However, a diamond blade can become so dull, chipped or broken that it can't be repaired. With diamond blades, it's important that everyone who might handle the knife — nurses, techs and sterilization staffers — know proper handling and care of these delicate instruments. Stainless steel blades offer a less expensive ($16 to $25) option.
The duty to keep up
If there's one constant in eye surgery, it's change. Whatever we do today will ultimately find its way into the history book of eye surgery as newer and better instruments are developed. Keeping up with change is the duty of the ophthalmologist as well as the surgical facilities where the latest procedures are performed.
Why Titanium? |
Because of the lights and magnification required for microsurgical procedures, it's best to use instruments that create as little glare as possible. Today, many instruments are made from anodized titanium with low-glare surfaces. Titanium's strength and light weight make it ideal for ophthalmic surgery instruments. |
Spring is the season for conferences and live events, which can go a very long way toward revitalizing your outlook....
The U.S. Food and Drug Administration (FDA) announced this week that its ongoing investigation of plastic syringes for potential failures has found that the use of...
People often rise to leadership positions due to the excellent quality of their work, but then may have a tough time letting go of that work in their new position....