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LETTER TO EDITOR
Year : 2019  |  Volume : 1  |  Issue : 1  |  Page : 13

Design of a new instrument for microsurgery in anterior and posterior segment


1 Department of Ophthalmology, Universidad Del Bosque, Bogotá, Colombia
2 Department of Ophthalmology, Clinica Oftalmologica De La Selva, Tarapoto, Perú

Date of Web Publication24-Oct-2019

Correspondence Address:
Dr. Eduardo Arenas Archilla
Carrera 21 No. 100-20 Piso 7, Bogotá
Colombia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/PAJO.PAJO_1_19

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How to cite this article:
Archilla EA, Herrera GA. Design of a new instrument for microsurgery in anterior and posterior segment. Pan Am J Ophthalmol 2019;1:13

How to cite this URL:
Archilla EA, Herrera GA. Design of a new instrument for microsurgery in anterior and posterior segment. Pan Am J Ophthalmol [serial online] 2019 [cited 2019 Dec 9];1:13. Available from: http://www.thepajo.org/text.asp?2019/1/1/13/269892



Otolaryngologists were the first physicians to use microsurgical techniques.[1] In ophthalmology, microsurgery is the standard technique for almost all procedures with continuous developments and new techniques and instruments being introduced. Here, we describe a new instrument called the “Hook Maker,” designed for micromanipulation of eye structures in surgical techniques and postoperative treatment in different segments of the eye.

The purpose of the Hook Maker is to modify disposable injection needles by creating different types of microbends. These 27-gauge needles act as a cutting or grasping instrument, with different bowls at the end that would dissect minimal amounts of tissue during the removal of small foreign bodies or hiding old sutures. This instrument can be used in anterior segment, cornea, glaucoma, and retinal techniques.

The instrument described here consists of two cylindrical stainless steel sections: one is a hollowed tube with a base for resting on a flat surface and the other is a handle and solid piston shaped at the end to attach a 27-gauge needle [Figure 1].
Figure 1: Arenas Hook Maker

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The piston tube has five different marks that indicate from how high the needle will drop down. Depending on the height from which the handle is dropped with the needle, the tip will be formed into different shapes, curvatures, and cutting ends, for the various medical or surgical maneuvers of the eyelids, conjunctiva, cornea, lens, anterior chamber, retina, and glaucoma [Figure 2].
Figure 2: The tip will be formed into different shapes, curvatures, and cutting ends, for the various medical or surgical maneuvers

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In [Figure 2], the procedure is illustrated.

There are five marks or degrees to determine the degree of curvature that will be formed at the tip of the needle according to the specific requirement:

  • Hook 1 [Figure 3]


    • Peeling of retinal membranes
    • Removal of intrastromal corneal foreign bodies.


  • Hook 2 [Figure 4]


    • Mini iridectomy
    • Removal of old 10 or 9-0 nylon corneal sutures
    • To mark the can opener capsulorrhexis
    • Endothelial corneal marker for Deep lamellar keraoplasty (DLK) procedures
    • Lachrymal tear point obstruction
    • Exploring and reopening failed antiglaucoma blebs.


  • Hook 3 [Figure 5]


    • Removal of uncomfortable or misplaced corneal rings
    • Small  Meibomian cyst More Detailss
    • AB-externo trabeculectomy.


  • Hook 4 [Figure 6]


    • Extraction of the anterior capsule in phacoemulsification
    • Removal of lid, conjunctival, or corneal sutures
    • Manipulation of sutures in intraocular lens on scleral fixation
    • Extraction of foreign bodies in the retina.


  • Hook 5 [Figure 7]


    • Extraction of the Descemet's membrane in DLK
    • Removal of inflammatory tissue in chalazion.
Figure 3: Hook tipe 1 for the peeling of retinal membranes

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Figure 4: Hook 2 can be applied in multiple procedures (form mini iridotomy to glaucoma surgery review)

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Figure 5: Hook 3 for removal of corneal rings and Ab-externo trabeculectomy

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Figure 6: Hook 4 is good in removing sutures

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Figure 7: Hook 5 can be used in removing Descemet's membrane in lamelar procedures

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Among all the mentioned functions, the main use is in AB-externo glaucoma surgery, because it is ideal for the unroofing of the Schlemm's channel and hypercolation of the aqueous humor by an opening of approximately 100 μ described by the author following Bernoulli's law [2] [Figure 8].
Figure 8: Unroofing of the Schlemm's channel

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The Hook Maker is a new and easy-to-handle microsurgical instrument with several different functions that demonstrate a clear benefit and it should be a standard equipment for all ophthalmic surgeons.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wheeler JR. History of ophthalmology through the ages. Br J Ophthalmol 1946;30:264-75.  Back to cited text no. 1
    
2.
Arenas E. La técnica de trabeculectomía ab externo. In: Boyd S, editors. Innovaciones de Glaucoma Primario de Angulo Abierto. 1st ed., Ch. 11. Panamá: Jaypee Highlights Medical Publisher; 2013. p. 141-9.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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