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 Other Common Instruments

 Bard-Parker ® Handle and blade:

Identification: It has a flat handle with a short-grooved neck. Handle no 3 is used in ophthalmic surgeries. No 11-triangular blade and NO 15 – curved elliptical tip blades are fitted with the neck of the handle.

Uses :
To make a groove at the limbus in ECCE
For skin incisions in various lid surgeries, DCR, Chalazion.
For suture removal

Advantage: It forms a guarded section and chance of quick decompression of the globe is reduced.
It can be used for biplanar or triplanar incisions giving rise to secure wounds.

Disadvantages: A conjunctival flap is necessary before creating a section


Iris Repositor:

Identification: It is an elongated S or Z shaped instrument with a stout handle and two long narrow flattened extremities. both the edges and tips are blunt. it’s one end may be curved and other end may be angulated.

Uses :
To reposit the iris in introcular surgeries
To perform synechiolysis
To fashion the conjunctiva to cover the wound
To check size and location of anterior chamber entry
To check for vitreous in the anterior chamber
To push the foldable IOL into the bag after delivery from injector.

Disadvantages:
If repositioning of iris is not done properly, it can cause
- iris incarceration at the wound
- gaping of the wound
- iris chaffing
- infection


IOL Dialer (Sinsky's hook)  

Identification: It is an angular fine hook attached to a long round solid handle. 0.6 mm tip; 10 mm straight shaft; 90-degree hook at tip; manipulating length 120 mm

Use:
To dial IOL for centration in the capsular bag. The hook is positioned in the dialling holes of the optic of IOL or the optic haptic junction and then to rotate in clockwise manner.
It may be used as a left hand/ second instrument during phacoemulsification to rotate, to crack or to chop nucleus.
Disadvantage: It needs careful handling since it can cause PC rent or zonular dialysis if handled roughly.


Muscle Hook:
Jamesons muscle hook
Stevens muscle hook
Von graphes muscle hook

Identificaion: It has a solid handle with a long narrow limb with 90 degree bent at its tip.The tip may be sharp or knobbed.
 

Uses:
Squint surgery
RD surgery to tag muscles
        -Enucleation
         Rarely as tissue retractor.
         For delivery of the nucleus in the bimanual technique of nucleus delivery in ECCE


Eye Speculum

Universal eye speculum

Identification: It has a spring and two limbs with a screw to adjust the limbs. It is called so as it can be used on either eye. When fixed to the eye ball the screw should face outwards.

Uses: It is used to separate the lids for good exposure of eyeball mainly during extraocular surgeries.
e.g.: pterygium excision, squint surgery, evisceration/enucleation, ocular surface procedures.
Disadvantage:
To be used for intraocular surgeries as they tend to increase the intra ocular pressure and cause vitreous up thrust and vitreous loss.
There is no guard, hence eye lashes can come into the operating field.

Wire speculum (Barraquer)

Identification - It is made up of stainless steel wire with no screw.
Advantage-It is very light so it causes less pressure on the globe so can be used safely during intraocular surgeries.


Bipolar Cautery

Principle: It uses Radiofrequency diathermy technology .The radiofrequency oscillations of the water molecules found within the blood cells generates heat within the vasculature causing coagulation.The current flows along the path of least resistance, between the tips of forceps and the coagulation region lies between the blade points. A well-defined coagulation patch is achieved by gentle wiping action of the instrument in a wet field.

Advantage: Limited depth and spread of coagulation.
Coagulation is done with saline which minimises tissue heating, shrinkage, sticking of coagulum to the electrodes
Ground plate is not required here which is required in monopolar cautery as the current flow is between the bipolar forceps.

Disadvantage:
Sometimes excess power can cause burns, charring, delayed wound healing and more scarring.
Improper earthing can cause shock hazards.
Can cause electromagnetic interference with other operating room devices.

CABLE
The bipolar cautery is connected to electrically isolated front panel output jacks through a flexible, two conductor, electrical cable.


Kaltz Needle holder

Description: Special pointed ends of Kaltz needle holder help in providing for a better grip of needles with locking handle. Overall length is 140 mm.

Uses:
Used in ophthalmic surgery for holding needles, to suture relatively larger structures like lids and superior rectus.
Also is used to prepare cystitome with 23 gauge needle


Baraquer's needle holder

Description: It has a smooth jaw which is curved as well as straight. It does not have a locking handle.

Advantage:
Good balance and light weight.
Offers desired strength and stability.

Uses:
For holding fine needles for 8-0 and 10-0 sutures
May be used for preparing cystitome if kaltz needle holder is not available