Contributing Physicians: Tom Harper, MD and James Major, MD
The Dutch Ophthalmic Research Center has recently developed a line of disposable instruments useful in retinal surgery. The design of these particular instruments has overcome many of the disadvantages of disposable microforceps and scissors previously on the market. The end-gripping forceps and curved scissors are particularly useful in cases of tractional retinal detachments, often seen in advanced diabetic retinopathy.
Our chief residents at Bascom Palmer Eye Institute were recently given the opportunity to demonstrate these new instruments in surgery. Below is their feedback on the 23 gauge disposable microforceps and scissors.
Dr. Harper had the privilege of trying the 23-gauge disposable single-use Eckardt end-gripping forceps (manufacturer serial number 1286.WD06).
The patient was a 62 year-old female with a tractional retinal detachment emanating from the inferior arcade. The patient had received intravitreal bevacizumab four days prior to surgery. After performing a core vitrectomy and shaving of the anterior peripheral vitreous, an attempt to induce a posterior peripheral detachment was unsuccessful. The end-gripping forceps were able to adequately engage the dense epiretinal membrane and lift the membrane and posterior hyaloid in one smooth motion. No intraoperative bleeding from the tractional retinal detachment site was encountered. As with the curved scissors, the instrument had excellent rigidity and performed similarly to standard 20-gauge instrumentation. The handpiece was comfortable in the hand and felt as sturdy and reliable as the non-disposable options. In many tractional retinal detachment repairs, it is difficult to obtain and maintain an adequate purchase on the pre-retinal membranes, the membrane often shredding like tissue paper during removal. This did not occur in this demonstration with the DORC forceps. Despite the necessity to torque the eye for adequate peripheral visualization, no distortion or bending of the instrument shaft was observed.
Dr. Major recently had the opportunity to try the DORC 23 gauge disposable curved horizontal microscissors (manufacturer serial number 1286.MD06).
The case was a 72-year-old poorly controlled diabetic with extensive tractional retinal detachments and a thick adherent posterior hyaloid face. The disposable scissors had a smooth handle action, were easy to hold and manipulate while in the eye, and were sharp enough to really help with delamination and segmenting of those tough tractional components. Although they feel like light weight disposable instruments in the hand, they had the strength to get the job done. The studded grip is of the “two piece” variety – some may prefer the 360 degree round handle similar to the popular Alcon Grieshaber intraocular retinal scissors. The scissor blades are somewhat short and action is directly proportional to the grip pressure. They were quite comparable to the power of a twenty gauge instrument. The scissor action itself is quite smooth and did not let the membranes within the mouth “slip out” as with some other, especially smaller gauge, instruments. The scissors were rigid enough to allow manipulation of the globe while inside the eye, enabling the surgeon to work in the periphery and other hard-to-reach or visualize places.
Although Drs. Harper and Major used these two instruments independently, based on their feedback, it is clear that these instruments would work well together in tractional retinal detachment surgeries.
Until now, disposable instruments of this sort did not quite meet the standards of the reusable instruments. Now with the release of these DORC Advantage microforceps and scissors, disposable options are available that offer an ergonomic design that is also cost-effective.
Below are quotes from Drs. Harper and Major which finalize their thoughts on these instruments.
“The DORC 23-gauge disposable Eckardt end-gripping forceps performed well in my demonstration, and I would recommend its use in conjunction with the curved scissors for dense pre-retinal proliferation requiring segmentation.” Tom Harper, MD
“DORC has produced a fine product which I would readily use and recommend.” James Major, MD
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