Instruments for Cataract

Surgery
By Trishan
Special thanks to Wilson Tudu
 Lid Speculums Forceps BLADES

Wire Speculum St. Martin’s Forceps Bard-Parker (BP) Handle

Lieberman Speculum Rhexis Forceps No. 15 Blade

Tooth-Dissecting Forceps No. 11 Blade

KNIVES
Superior Rectus Forceps
Sideport Knife SCISSORS
Suture Tier
Crescent Knife Corneal Scissor
McPherson Forceps
Keratome Knife Vannas Scissor

Simcoe’s Biway Irrigation

Barraquer Needle Holder Cystotome Corneal
Aspiration Cannula
Irrigation
Wire Vectis Irrigating Vectis Sinskey Hook Canula
LID SPECULUMS
Wire Speculum
 Very light, handy, malleable, made up of metallic wire and causes minimal
pressure to the eyeball.
 No screw to adjust the limbs. Desired interpalpebral diameter can’t be
achieved.
 Used to keep eyelids apart during intraocular surgeries.
 Lieberman Speculum
 Has a spring mechanism with a screw to adjust the limbs.
 Heavier than wire speculum, but the desired intrapalpebral aperture can
be achieved by adjusting the screw.

The adjustable screw

Eye speculums are used to keep the
eyelids apart during :
 Interocular operations such as cataract surgery, glaucoma surgery,
keratoplasty etc.
 Extraocular surgeries i.e. squint surgery, pterygium surgery.
 Enucleation and evisceration operation.
 Removal of corneal or conjunctival foreign body.
 Cauterization of corneal ulcer.
 Examination of the eye in a patient with blepharospasm.
 Toothed Non-toothed
Forceps Forceps
• St. Martin’s Forceps • Suture tier
• Rhexis Forceps • McPherson Forceps
• Tooth-dissecting Forceps
• Superior Rectus Forceps
St. Martin’s Forceps (Saint
Martin’s)
(Toothed)
 This is a fine toothed (1x2) forceps. Lower
part is very delicate, upper part is thick
and strong.
 It is used to hold the edge of the incision
of delicate tissues like cornea, posterior
lip of sclera during suturing.
Rhexis Forceps
(Toothed)
 These are fine-tipped forceps with toothed tip on a gradually tapering end.
 Used for capsulorhexis in SICS or conventional ECCE.
Tooth-dissecting Forceps
(Toothed)
 These are larger, heavier forceps with tooth at the tip.
 Used to hold gross structures, often used in dacryocystorhinostomy (DCR) or
dacryocystectomy (DCT) etc.
 Superior Rectus Forceps
(Toothed)
 It is a toothed forceps (1x2 teeth) with S-shaped
double curve near the tip. The curvature fit the
shape of the eyeball.
 Used to lift up the belly of superior rectus muscle,
while passing a bridle suture under it.
 May be used to stabilize the eyeball during any
surgeries i.e. cataract surgery, glaucoma surgery,
corneal surgery etc.
Suture Tier
(Non-toothed)
 These are small, straight, toothless forceps and their tips are
made thicker.
 They are used to hold suture ends of 10-0 or 11-0 sutures
during tying or removing suture knot.
 Other than cataract surgery, they can be used to remove
caterpillar hair.
McPherson Forceps (Non-toothed)
 These are non-toothed fine forceps, jaws are smooth, bent, and gradually
tapering.
 It is used to hold the artificial intraocular lens.(The lens is held at optic-haptic
junction), may be used to hold fine suture end like 10-0 or 11-0, during
suture tying or removal of suture knot.
 Also used to hold the loose anterior capsule during capsulotomy or
capsulorhexis.
 Sideport Knife/Lancetip Knife
 It is a fine straight knife with a
very sharp triangular pointed
tip and cutting edge on one
side.
 It is used to make small
valvular clear corneal incision
(Sideport incision) in
phacoemulsification.
 Other than cataract surgery, it
is also used in pars plana
vitrectomy.
Crescent Knife
 It is blunt-tipped, beveled up knife having tongue-shaped, angulated
blade with cut-splitting action at the tip and both the sides
 Used in Sclerocorneal tunneling during SICS, phacoemulsification and
sutureless trabeculectomy.

 Other than cataract, may be

used in trabeculectomy to
Separate conjunctiva and
Sub-conjunctival tissue from
Sclera and limbus. Also used
To separate pterygium
Head or limbal dermoid.
Keratome Knife
 A keratome has a thin diamond-shaped blade, with a sharp apex and two
cutting edges, straight as well as angulated blade are available.

 Keratomes are used to make valvular corneal incisions for entry in anterior
chamber for cataract surgeries (SICS, phacoemulsification, ECCE) and
other surgeries (iridectomy,
Paracentesis etc.)
Bard-Parker Handle (BP Handle)

 It is a flat handle with a short grooved neck.

 11 and 15 size blades are mounted on it for incision purpose.
No. 15 Blade fitted in
Bard-Parker Handle
 Tongue-shaped tip.
No. 11 Blade fitted in
Bard-Parker Handle
 Triangular Tip.
 Used in SICS.
SCISSORS
Corneal Scissor
 These are small curved spring scissors used to cut and
undermine conjunctiva and skin.
 They are used to enlarge corneo-scleral section at the
limbus, and useful for conjunctival flap preparation.
 Other than cataract surgery, they are also used to cut the
corneal button from the donor and recipient eye in case
of keratoplasty.
Vannas Scissor

 Very fine delicate scissors with small cutting blades kept

apart by spring action. Blades may be straight or curved.
 It may be used for cutting anterior capsule.
 Used for cutting 10-0 nylon sutures.
 It is used in peripheral iridectomy.
 Used for cutting inner scleral flap in trabeculectomy.
 Used for pupillary sphincterotomy.
 Maybe used for cutting pupillary membrane.
OTHERS
Barraquer Needle Holder
 Available in various sizes, with straight or curved tips,
in different shape or size, may be with or without
locking system.
 The jaws of the needle holder is finely serrated to
hold the fine needles firmly.
 Used to hold needle for passing sutures in the
conjunctiva, cornea, sclera and extraocular muscles,
like bridle suture of superior rectus. (Suture is not
given in SICS or Phacoemulsification)
 Cystotome
 It is a small bent knife with a bent tip
which is sharp on both the edges.
 Prepared by bending a 26 gauge or
30 gauge hypodermic needle using
Barraquer Needle Holder.
 Used for anterior capsulotomy
during extracapsular cataract
extraction.
 Bi-way Irrigation-Aspiration Cannula/
Simcoe Cannula
 It has two openings, the opening for
irrigation is situated at one side of the tip,
from where irrigating fluid is forcefully
introduced, through a blood-transfusion set.
Balanced salt solution should be used
ideally as the irrigating fluid, but here we
use Ringer-Lactate (RL), which is isotonic to
the aqueous humor.
 Aspiration port is a small hole at the tip.
Through this, cortical materials are aspirated
in a 5cc syringe through a plastic tube.
 It is used for irrigation and aspiration of lens
matter in extracapsular cataract extraction.
 Can be used for extraction of hyphaema.
Vectis (Wire Vectis)
 It’s an wire loop attached on a metallic handle.
 Used to take out the nucleus of the lens. Here, Vectis is held in left hand
and the Sinskey Hook is held in right hand. Nucleus is taken out by applying
pressure with Vectis and counter pressure is applied on the limbus at 6
o’clock position using Sinskey hook.
 Irrigating Vectis
 It is a modified Vectis in which the loop is made up of thick hollow
wire. Anterior end of the loop has three 0.3mm openings and the
posterior end of the loop is continuous with a hollow handle. The
posterior end of the handle has a hub similar to that of a hypodermic
needle to which attached a syringe or infusion set.
 Size of the loop differs, in most commonly used wire vectis, the loop is
4mm in width and 8-9mm in length. Superior surface of the loop has a
slight concavity to accommodate the lens nucleus.
 It is most commonly used in SICS and in conventional ECCE to deliver
the lens nucleus by hydro-expression or visco-expression technique.
Sinskey Hook / Dialer

 It is a fine but stout instrument with a bent tip. The tip

engages the dialing hole of the IOL.
 It is used to ---
1. To give counter pressure while taking out the nucleus.
2. To dial the PMMA non-foldable intra-ocular lens for proper
positioning in the capsular bag.
3. Can also be used to manipulate the nucleus in
phacoemulsification, may be in the form of nuclear
rotation in capsular bag, cracking of the nucleus and
feeding of the nuclear fragments into the phaco-tip.
Corneal Irrigation Cannula

• Used for irrigation (and moistening) of cornea

during intraocular surgeries such as cataract
surgeries.
Texts taken from K. P. Baidya (Practical)
and A. K. Khurana (Theory)…