Iris Retractors

GL BE
NEWS
VOLUME 16 NUMBER 1
Managing Floppy Iris Syndrome
Katena retractors
for flexibility,
strength and
control
At the 2005 ASCRS meeting, David
F. Chang, MD and John Campbell,
MD presented their study on
Intraoperative Floppy Iris Syndrome
(IFIS), winning both a Best Paper of
Session award and the Cataract
Complications film competition.
Alpha-1 blockers, such as Tamsulosin
(Flomax), are the most commonly
prescribed medications for benign
prostatic hyperplasia, but also block
the iris dilator smooth muscle,
causing a loss of iris rigidity. IFIS is
characterized by iris billowing and
prolapse, and progressive miosis that
complicates cataract surgery.
Katena introduces polypropylene
Flexible Iris Retractors for the
strategic management of IFIS and
other causes of operative small
pupils. These tiny, bright blue 4-0
retractors are 10mm long and easily
visible as they are inserted through a
small stab incision. Dr. Chang
advocates using 4-0 polypropylene
retractors as they are more rigid and
easier to manipulate than 6-0 nylon
retractors. To obtain maximum
exposure, four retractors are inserted
in a diamond configuration. Once
inserted, each retractor can be rotated
until the hook engages the pupillary
margin. The iris is then expanded by
gently pulling the retractor with a
forceps and locked into the expanded
position by sliding the clear silicone
donut down the shaft and against the
cornea. Following surgery the iris is
released by sliding the silicone donut
away from the cornea, unhooking the
iris and carefully pulling the retractor
back out through the stab incision.
Dr. Chang has produced a narrated
teaching video demonstrating this
technique which can be viewed at
www.katena.com, it is also available
on CD from Katena upon request. He
photo courtesy of David F. Chang, MD
Four retractors inserted in diamond configuration
has also written an article on using
iris retractors for IFIS in the
September 2006 issue of Cataract &
Refractive Surgery Today.
continued on page 2
Ultra Delicate Forceps for MICS
K5-5090 Giannetti Capsulorrhexis Forceps
Dr. Riccardo Giannetti of Livorno, Italy designed this forceps to perform a
capsulorrhexis through a 1.5mm micro incision. It features very thin shanks that
are less than 1mm wide in the closed position and are limited to a maximum
spread of 2mm. The extremely small, delicate tips can be used to make the initial
tear as well as to grasp the capsule while performing a capsulorrhexis. The shanks
are angled and vaulted to provide better access to the capsule without stretching
the incision, and the 8.5mm diameter round handle is ergonomically designed for
better control. According to Dr. Giannetti, the forceps works equally well when
performing an anterior or posterior capsulorrhexis.
Multifunction MICS HydroChoppers
MICS “Stinger”
Alio Irrigating
Professor Jorge L. Alio, MD of Alicante, Spain, a pioneer in the development of
Micro Incision Cataract Surgery (MICS), designed this 19-gauge irrigating
chopper. Prof. Alio states, “This is not a modification of existing choppers or
irrigators, but instead is a culmination of my experience with MICS.” The
“stinger” can be used for efficient division of both soft and hard nuclei. It features
a bullet shaped head which is ideal for MICS as it can be easily introduced
through the micro incision. The 19-gauge cannula seals the micro incision
preventing leakage, while the large (1mm) irrigation port provides stable fluidic
control during phaco. The multifunctional irrigating “stinger”
can be used to prevent occlusion of the aspiration tip, to stretch
a small pupil and to maintain the capsular bag during lens
insertion. A video describing the advantages of the “stinger”
is available for viewing at www.katena.com and on CD from
Katena upon request.
Fukasaku
Hydro Chop
Cannula
Most surgeons agree that nucleus
division or prechopping of the
nucleus makes phacoemulsification
through a micro incision easier. This
new 23-gauge cannula has been
designed by Hideharu Fukasaku,
MD of Yokohama, Japan to perform
nucleus division through a micro
incision using the Fukasaku Hydro
Chop Technique.*
It features a
vertically
flattened tip which is
easily
inserted
into the central
K7-5861 Alio-Prats Irrigating Stinger
Giannetti HydroChopper
This HydroChopper designed by Dr. Riccardo Giannetti of
Livorno, Italy features a unique chopping tip which is ideal for
both nucleus division and for manipulating fragments within
the capsular bag. The hourglass shaped tip has a blunted distal
end to protect the posterior capsule and semi-sharp sides which
aid in efficient horizontal chopping. The inferior surface of the
chopper tip is concave in shape to capture and control nuclear
fragments while feeding the phaco probe. Its 20-gauge thin
wall irrigation tube provides maximum flow to maintain the
chamber during phaco surgery. The symmetrical design
permits the surgeon to use it in either hand for true
bimanual performance.
K7-5885 Giannetti Hydro Chopper
Managing Floppy Iris Syndrome
continued
K7-5462
Fukasaku Hydro Chop Cannula
core of the nucleus. The nucleus is
then “hydro chopped” as a small
amount of fluid is forced through the
dual 0.2mm sideports to fracture
the nucleus along
its meridional
stress lines. If
the nucleus is
soft, it is easy to
insert the Hydro Chop tip without the
use of a second instrument. For harder
nuclei (+ grade 3) the Fukasaku
Snapper Hook (K3-2392 shown above)
is used for stabilization as the
Hydro Chop tip is inserted. This
cannula can be easily used through
incisions as small as 0.7mm.
* view technique video at www.katena.com
To address varying OR requirements,
Katena makes these retractors available
in one of two options; a cost-effective
reusable set with an autoclavable
sterilizing case or as a disposable,
sterile, single-use set.
Disposable / Sterile
K20-3890 Set of 5 retractors
K20-3892 5 sets of 5 retractors
K3-4970
Reusable / Non-Sterile
K3-4970 6 retractors in case
photo courtesy of
Hideharu Fukasaku, MD
Fluid expressed through dual 0.2mm ports
DSEK Instruments
!
NewMultipurpose
Lacrimal Cannula
Corneal surgery is undergoing tremendous change with the development of
new procedures. Posterior lamellar surgical techniques, once unthinkable,
are now becoming standard procedures as microsurgical instrumentation
and techniques evolve. Working with George Rosenwasser, MD of Hershey,
PA., Katena has developed a range of instrumentation* for these new
techniques. Descemet’s Stripping Endothelial Keratoplasty (DSEK) is one
of the most popular and effective lamellar techniques to replace a diseased
or damaged endothelial layer.
K7-3016 Burnstine Cannula
Irrigating
Endothelial Stripper
Features a thin, semi-circular tip which is
angled 90° upward from the tube to
gently peel and remove the endothelial
layer. The 20-gauge irrigation tube helps
to maintain the chamber thereby reducing
dependence on viscoelastics.
K7-5897
Reversed Sinskey Hook
Features a 0.2mm diameter blunted tip
which is angled 90° upward. It is used to
score the periphery of the patient’s
endothelial layer prior to removal by the
stripper. The hook is also great for
manipulating the donor lamella into
position following insertion.
K3-5002
Donor Lamella Shovel
Features a 9mm x 5mm platform with a
retaining rim on 2 sides to prevent the
folded donor lamella from sliding off
during insertion. This instrument
facilitates easy insertion without grasping
the tissue.
* visit www.katena.com for a complete listing of DSEK instruments.
“The ideal lacrimal
cannula should be
easy to use,
require minimal
instrumentation
and be comfortable
for the patient.”
Michael A. Burnstine, MD
K3-4262
Donor Lamella Inserting Forceps
Features very thin vaulted shanks and a
precalibrated heel stop. This design
prevents the tips from completely
closing, providing enough space to
securely hold the folded donor lamella
without crushing the tissue.
Designed by Michael A.
Burnstine, MD of Pasadena,
California, this new 23gauge cannula features an
end opening port for direct
irrigation and a bullet shaped
tip for ease of insertion into
an undilated punctum. The
13mm length makes the
cannula ideal for probing as
well as
irrigating the
proximal lacrimal system. It
eliminates the need for
K5-8010
placement of Bowman
probes to dilate the punctum
and measure canalicular
obstruction. The end opening
irrigation port prevents
misdiagnosis in the setting of
canalicular stenosis. The
cannula can also be used to
assess tear drainage system
patency in patients with
ectropion involving the
punctum, patients with
punctal
stenosis/agenesis
and in patients with
medial canthal tumors.
Diamond Knives for Limbal Relaxing Incisions (LRI)
K2-6519 LRI Diamond Step Knife, 500, 550, 600 microns
These knives feature titanium handles and
gem quality diamond blades with 6-facet
double bevel edges for bi-directional
cutting. The single, highly polished
footplate provides a smooth gliding
surface and serves as a depth guard while
permitting full visualization of the blade.
The combination of these features allow
the surgeon to make a clean and accurate
limbal relaxing incision at a precise depth.
K2-6518 LRI Diamond Step Knife, 600 microns
Katena produces two models of these LRI
knives; one has a single 600 micron depth
setting and the other has three preset depth
settings of 500, 550 and 600 microns.
Barron Artificial Anterior Chamber
Cut the donor cornea from the epithelial side
This artificial anterior chamber is the newest addition
to the Barron family of products from Katena. It is the
only sterile, disposable A/C currently available in
the world. The Barron Artificial Anterior Chamber
allows the surgeon to firmly hold the donor cornea,
inflate it and cut it from the epithelial side. By cutting
both the recipient and donor cornea from the epithelial
side the best donor-to-host match is achieved thereby
reducing surgically induced astigmatism.
In addition to corneal transplant surgery the Barron
Artificial Anterior Chamber is ideal for other
procedures including ALK, DLEK, and DSEK. It is
designed to be used with the Barron Vacuum Trephine
but also works well with a femtosecond laser system.
4 Stewart Court, Denville, NJ 07834• USA
Its ease of use, minimal cost, and sterile, disposable
packaging make it the device of choice for surgeons and
OR personnel around the world.
K20-2125
973-989-1600 • 800-225-1195• FAX 973-989-8175 • www.katena.com