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Adapting retinal instruments to anterior segment surgery
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I've always been impressed by our retinal colleagues because of their surgical skill and their innovative instruments. When Robert Machemer, MD, developed the first pars plana vitrectomy instruments, he revolutionized the field of retinal surgery. Today that tradition continues with small-gauge instrumentation and extremely fine instrumentation. When I see a skilled surgeon peel an epiretinal membrane off a macula, it leaves me in awe. It makes our capsulorrhexis look like a walk in the park.
 Micro-capsulorrhexis forceps are used in a pediatric lens surgery. |
These fine and precise retinal instruments have been adapted for anterior segment use. Small-gauge capsulorrhexis forceps look similar to the instruments that are used for peeling epiretinal membranes.
They are small-gauge, able to fit into a paracentesis incision and extremely accurate. The advantage is the ability to maintain a closed system and keep the anterior chamber pressurized during capsulorrhexis creation. This allows flattening of the anterior lens capsule and more control. The concept of operating in a closed system is also an adaptation from our vitreoretinal colleagues.
In the case shown here, small-gauge capsulorrhexis forceps are used to create a round, well-controlled capsulorrhexis in the lens of a 9-year-old child with progressive posterior lenticonus. With older-style forceps and a non-closed system, this would be very difficult. But with the retinal-style techniques, it becomes quite feasible.
Sometimes I wonder if it's too late for me to do a retina fellowship ...