Instrument Insider
Ikeda Super Micro Capsulorrhexis Forceps from American Surgical Instruments Corp. (ASICO)
Reviewed by Mark Packer, M.D. 

Bi-manual micro-incision cataract surgery is an exciting new approach to cataract extraction, offering important advantages such as increased chamber stability, improved fluidics and greater flexibility. However, it also presents new challenges.

One of the first challenges surgeons confront when performing this kind of surgery is capsulorrhexis construction. Incision size creates the initial difficulty: The instrument must pass through a 0.8-mm internal incision. Then the instrument must initiate the capsular tear and allow the surgeon to extend the tear in a carefully controlled curvilinear design. This requires specially designed forceps, and the Ikeda Super Micro Capsulorrhexis Forceps (AE-4385) from ASICO have the right characteristics to do the job.

The Ikeda Super Micro Capsulorrhexis Forceps (AE-4385) are designed for easy construction of the capsulorrhexis during bi-manual micro-incision cataract surgery.

Working in Tight Spaces

Surgeons familiar with capsulorrhexis construction through a standard 2.5-mm clear corneal incision know that while the surgeon's fingers maintain and reposition the tips of the forceps on the capsular flap, the motion that actually tears the tissue comes from the wrist. However, when the incision size is reduced to 1.0 mm or less, wrist action is limited because the fulcrum of motion is effectively immobilized. As a result, the surgeon's fingers have to mediate the action of capsulorrhexis construction.

The Ikeda Super Micro Capsulorrhexis Forceps (AE-4385) allow consistent, flawless capsulorrhexis construction. The slim 23-gauge curved tip easily fits through the 20-gauge incision with the jaws closed. Once inside, the jaws open sufficiently to pinch the anterior capsule and initiate a smooth tear. (Alternatively, the closed jaws can be used to pierce the capsule as one might with a bent needle cystotome.) The micro platforms incorporated into the tips permit exquisite tissue control; the curved arm of the forceps and round handle facilitate finger manipulation during completion of the rhexis. At the same time, the distal location of the tips insures that no edges snag the inner margin of the corneal incision when the tear is brought around into the subinicisional region.

Making the Rhexis

My technique begins with temporal paracentesis incisions at 4:30 and 10:30 o'clock. I instill preservative-free lidocaine to enhance the topical anesthesia, and then exchange aqueous for viscoelastic.

I perform the capsulorrhexis with my right hand. First, I extend the jaws to their full extent; I rest the tips on the center of the anterior capsule and pinch, using the forceps' wide jaws to capture a knuckle of tissue. Next, I draw the knuckle of capsule tissue to my left to start the tear. As the capsular flap extends, I regrasp it nearer to its origin to maintain control over the direction of the tear, manipulating the forceps with finger movements.

By starting centrally and tearing in a spiral fashion I'm able to incorporate the site of the initial tear within the rhexis. This insures that the edge of the flap forms a smooth continuous circle.

Dr. Packer is a board certified ophthalmologist in private practice in Eugene, Ore., and assistant clinical professor of ophthalmology at Oregon Health Sciences University.