Abstract
Purpose: :
Because of limitations caused by straight instruments in vitrectomy surgery, we devised a method of curving 25 and 23 gauge vitrectomy cutters, light probes, laser probes, aspiration cannulas, scissors, and cautery tips. We observed the effect of using curved tips in a variety of tasks.
Methods: :
The goals were to produce a constant curve in various instrument tips that enabled the tips to pass through the sleeves used in 25 and 23 gauge vitrectomies and to make these curves using objects generally available during vitrectomy. Wrapping 25 gauge tips around a 60ml syringe (Becton, Dickinson, Franklin Lakes, NJ), with a radius of curvature (R) of 15mm, and 23 gauge tips around a 30 diopter indirect ophthalmoscopy lens (Volk Optical, Mentor, OH), with R = 22.5mm, produced the proper curve for 25 and 23 gauge tips. During the curving of the vitrectomy cutters (Alcon Corporation, Fort Worth, TX), the port was oriented to point toward the concave side. Curved instrument tips were used in 80 vitrectomies.
Results: :
The 25 gauge and 23 gauge vitrectomy cutters each had a curve of R=140mm. All curved 25 and 23 gauge vitrectomy cutters maintained the same cutting ability and rates they had prior to curving. The syringe curved the 25 gauge light pipe to R = 90mm. The process of curving an instrument tip took less than 15 seconds. All the instruments passed through the sleeves without interference. Curving vitrectomy instruments made several tasks easier. Curved vitrectomy cutters could reach basilar vitreous without torquing the eye and without touching the crystalline lens. Unwanted light reflections could be reduced by twisting the curved light probe. Curving the scissors shaft permitted cutting at a flatter angle to the retina. Curving the various tips minimized access problems from the nose and from the wide angle contact lens. If a precurved laser tip was not available, a straight laser tip could be curved.
Conclusions: :
The ability to curve the tips of vitrectomy instruments during surgery allows the surgeon to decide when to curve the tips. The capability of reaching the peripheral vitreous and retina without torquing the eye reduces the difficulty of reaching peripheral structures with flexible instruments. The simple act of curving vitrectomy cutters and instruments during surgery has the potential to change the way a majority of surgeons do vitrectomy.
Keywords: vitreoretinal surgery • retinal detachment