New Instruments open laterally, and trying to place this caliper in the meridional direction is sometimes difficult because of the orbital bones and limited space. Therefore, we have developed a new caliper with technical assistance of ASICO, LLC (Westmont, IL) that can be inserted deeper into the orbit.
DEVELOPMENT OF CALIPER FOR SCLERAL MEASUREMENTS DURING SCLERAL BUCKLING SURGERY Tetsu Asami, MD, PHD Hiroko Terasaki, MD, PHD From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Aichi, Japan.
Characteristics of New Caliper for Scleral Buckling Surgery
Retinal detachments have been treated by closing the tears and removing the traction, because Gonin1 determined that retinal detachments were due to retinal tears caused by vitreous traction. Scleral buckling surgery has been the main procedure to close the retinal breaks since Custodis2 developed this procedure. Advances in vitreoretinal surgery, for example, microincision vitreous surgery with 23-gauge to 27-gauge instruments3 have made vitreous surgery less invasive, and more surgeons have shifted from scleral buckling surgery to vitreous surgery to treat retinal detachments. Nevertheless, scleral buckling surgery is a more appropriate treatment for some types of retinal detachments, for example, in eyes with an atrophic retinal hole in lattice degeneration, in eyes when the posterior vitreous is still attached, and in eyes with concentrated and viscous subretinal fluid. When a buckle is sutured on the sclera during the buckling procedure, mattress sutures are placed along the width of the buckle plus 2 mm. If the retinal tear is located deep in the posterior pole, the posterior position of the sutures can be near a vortex vein. Importantly, the space for the suturing procedure is limited to the space near the superior and inferior rectus muscles and on the nasal side where the orbital part of the frontal bone and the orbital margin of the superior maxillary bone are prominent. A Castroviejo caliper, which is generally used to measure the length of the scleral incision during cataract surgery, has been used to measure the length of the intended mattress suture. However, the tips of the Castroviejo caliper
The caliper is based on the principles of the Vernier caliper (Figure 1). The jaws of the caliper are oriented in the same plane as the shaft, and the tips can be placed against the sclera. The tips are pointed but not sharp enough to puncture the sclera (Figure 2). When the length of the sutures is selected, the lock screw is loosened, and the distal jaw is moved outward with the inner cylinder sliding out. The scale is on the side of the main body, and the screw is tightened to fix a preplanned length. Clinical Use of Caliper We present our procedures that were used on a 16year-old young boy with a history of laser treatment for retinopathy of prematurity in both eyes. He had anterior proliferative vitreoretinopathy in his left eye that required vitrectomy combined with a 7-mm-wide encircling band to reduce the tractional force of the anterior proliferative membrane. Initially, a Castroviejo caliper was tried to measure a 9-mm length meridionally from the insertion of rectus muscles. On the temporal side, it was easy to insert the posterior tip of the caliper, however, it was difficult to insert it on the nasal side because of the limited space. The tip of the caliper on the peripheral side was pressed firmly against the sclera for the
None of the authors have any financial/conflicting interests to disclose. Reprint requests: Tetsu Asami, MD, PhD, Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan; e-mail: [email protected]
Fig. 1. Photograph of the newly developed scleral caliper. The caliper is an adaptation of the Vernier caliper.
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2014 VOLUME 34 NUMBER 8
Fig. 2. Magnified view of the jaws of the caliper. The tip of the caliper is sharpened and aligned vertical to the shaft so that the tip end can be placed on the sclera vertically. The length from the tip end to the shaft (between two lines) is long enough for the shaft not to touch the sclera.
posterior tip to touch the posterior sclera (Figure 3A). The yellowish arrow in Figure 3, A and B shows a vortex vein, which means that the marked spot was very deep. Next, the newly developed caliper was used. The distance of the jaws was fixed at 9 mm, and the caliper was inserted. The anterior jaw reached the posterior sclera without any difficulty (Figure 3B). The length of the jaws (distance between 2 lines in Figure 2) was long enough for the shaft not to touch the scleral surface when measurements were being made. Marks were made by putting pyoktanin blue on the tips of the jaws. This new caliper was very easy to insert into the small space in the orbit, and this made it less stressful for surgeons. There were no complications related to the use of this caliper. In conclusion, we have developed a new scleral Vernier caliper suitable for measurement of the length of the sutures needed for scleral buckling surgery. The caliper can be inserted into a limited space between the scleral and orbital bones. The tip of the caliper can reach the posterior marking spot without any difficulty. This caliper is commercially available. Key words: caliper, scleral buckling, retinal detachment, sclera, mattress suture, vortex vein, retinal tear, buckle. Acknowledgments The authors thank ASICO, LLC for their technical contributions in the developing process of the device. The authors thank to ASICO, LLC for their technical contributions in the developing process of the device, and also thank to Professor Duco Hamasaki of the Bascom Palmer Eye Institute of the University of
Fig. 3. Intraoperative findings using the two types of caliper in the inferior nasal side. A. The posterior tip of Castroviejo caliper hardly reached the posterior marking spot. B. The tip of the newly developed caliper can easily reach the posterior marking spot. Yellowish arrow indicates a vortex vein.
Miami for his critical discussion and final manuscript revision. References 1. Gonin J. The evolution of ideas concerning retinal detachment within the last five years. Br J Ophthalmol 1933;17:726–740. 2. Custodis E. Treatment of retinal detachment by circumscribed diathermal coagulation and by scleral depression in the area of tear caused by imbedding of a plastic implant [in German]. Klin Monbl Augenheilkd Augenarztl Fortbild 1956;129:476–495. 3. Oshima Y, Wakabayashi T, Sato T, et al. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology 2010;117:93–102.
DEVELOPMENT OF CALIPER FOR SCLERAL MEASUREMENTS DURING SCLERAL BUCKLING SURGERY Tetsu Asami, MD, PHD Hiroko Terasaki, MD, PHD From the Department of Ophthalmology, Nagoya University Graduate School of Medicine, Aichi, Japan.
Characteristics of New Caliper for Scleral Buckling Surgery
Retinal detachments have been treated by closing the tears and removing the traction, because Gonin1 determined that retinal detachments were due to retinal tears caused by vitreous traction. Scleral buckling surgery has been the main procedure to close the retinal breaks since Custodis2 developed this procedure. Advances in vitreoretinal surgery, for example, microincision vitreous surgery with 23-gauge to 27-gauge instruments3 have made vitreous surgery less invasive, and more surgeons have shifted from scleral buckling surgery to vitreous surgery to treat retinal detachments. Nevertheless, scleral buckling surgery is a more appropriate treatment for some types of retinal detachments, for example, in eyes with an atrophic retinal hole in lattice degeneration, in eyes when the posterior vitreous is still attached, and in eyes with concentrated and viscous subretinal fluid. When a buckle is sutured on the sclera during the buckling procedure, mattress sutures are placed along the width of the buckle plus 2 mm. If the retinal tear is located deep in the posterior pole, the posterior position of the sutures can be near a vortex vein. Importantly, the space for the suturing procedure is limited to the space near the superior and inferior rectus muscles and on the nasal side where the orbital part of the frontal bone and the orbital margin of the superior maxillary bone are prominent. A Castroviejo caliper, which is generally used to measure the length of the scleral incision during cataract surgery, has been used to measure the length of the intended mattress suture. However, the tips of the Castroviejo caliper
The caliper is based on the principles of the Vernier caliper (Figure 1). The jaws of the caliper are oriented in the same plane as the shaft, and the tips can be placed against the sclera. The tips are pointed but not sharp enough to puncture the sclera (Figure 2). When the length of the sutures is selected, the lock screw is loosened, and the distal jaw is moved outward with the inner cylinder sliding out. The scale is on the side of the main body, and the screw is tightened to fix a preplanned length. Clinical Use of Caliper We present our procedures that were used on a 16year-old young boy with a history of laser treatment for retinopathy of prematurity in both eyes. He had anterior proliferative vitreoretinopathy in his left eye that required vitrectomy combined with a 7-mm-wide encircling band to reduce the tractional force of the anterior proliferative membrane. Initially, a Castroviejo caliper was tried to measure a 9-mm length meridionally from the insertion of rectus muscles. On the temporal side, it was easy to insert the posterior tip of the caliper, however, it was difficult to insert it on the nasal side because of the limited space. The tip of the caliper on the peripheral side was pressed firmly against the sclera for the
None of the authors have any financial/conflicting interests to disclose. Reprint requests: Tetsu Asami, MD, PhD, Department of Ophthalmology, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan; e-mail: [email protected]
Fig. 1. Photograph of the newly developed scleral caliper. The caliper is an adaptation of the Vernier caliper.
1713
1714 RETINA, THE JOURNAL OF RETINAL AND VITREOUS DISEASES
2014 VOLUME 34 NUMBER 8
Fig. 2. Magnified view of the jaws of the caliper. The tip of the caliper is sharpened and aligned vertical to the shaft so that the tip end can be placed on the sclera vertically. The length from the tip end to the shaft (between two lines) is long enough for the shaft not to touch the sclera.
posterior tip to touch the posterior sclera (Figure 3A). The yellowish arrow in Figure 3, A and B shows a vortex vein, which means that the marked spot was very deep. Next, the newly developed caliper was used. The distance of the jaws was fixed at 9 mm, and the caliper was inserted. The anterior jaw reached the posterior sclera without any difficulty (Figure 3B). The length of the jaws (distance between 2 lines in Figure 2) was long enough for the shaft not to touch the scleral surface when measurements were being made. Marks were made by putting pyoktanin blue on the tips of the jaws. This new caliper was very easy to insert into the small space in the orbit, and this made it less stressful for surgeons. There were no complications related to the use of this caliper. In conclusion, we have developed a new scleral Vernier caliper suitable for measurement of the length of the sutures needed for scleral buckling surgery. The caliper can be inserted into a limited space between the scleral and orbital bones. The tip of the caliper can reach the posterior marking spot without any difficulty. This caliper is commercially available. Key words: caliper, scleral buckling, retinal detachment, sclera, mattress suture, vortex vein, retinal tear, buckle. Acknowledgments The authors thank ASICO, LLC for their technical contributions in the developing process of the device. The authors thank to ASICO, LLC for their technical contributions in the developing process of the device, and also thank to Professor Duco Hamasaki of the Bascom Palmer Eye Institute of the University of
Fig. 3. Intraoperative findings using the two types of caliper in the inferior nasal side. A. The posterior tip of Castroviejo caliper hardly reached the posterior marking spot. B. The tip of the newly developed caliper can easily reach the posterior marking spot. Yellowish arrow indicates a vortex vein.
Miami for his critical discussion and final manuscript revision. References 1. Gonin J. The evolution of ideas concerning retinal detachment within the last five years. Br J Ophthalmol 1933;17:726–740. 2. Custodis E. Treatment of retinal detachment by circumscribed diathermal coagulation and by scleral depression in the area of tear caused by imbedding of a plastic implant [in German]. Klin Monbl Augenheilkd Augenarztl Fortbild 1956;129:476–495. 3. Oshima Y, Wakabayashi T, Sato T, et al. A 27-gauge instrument system for transconjunctival sutureless microincision vitrectomy surgery. Ophthalmology 2010;117:93–102.
