Literally hundreds of phacomanipulators, rotators andchoppers have been developed

since the introduction of phacoemul-sification for cataract surgery by Dr.Charles Kelman in the late nineteensixties. As more and more surgeonslearned to use phacoemulsification,new surgical techniques were devel-oped along with new instruments tohelp implement those techniques.One of the first instruments for rotat-ing the nucleus and feeding it intothe phaco tip wasdesigned by Dr.Charles “Skip”Bechert of FortLauderdale, Florida and he named itthe Bechert Nucleus Rotator. It fea-tures a Y-shaped tip for rotating and manipulating the nucleus. Dr.Norman Jaffe modified the Bechertrotator, increasing its length to 9mmso that it could easily be usedthrough a sideport incision. Some 30 years later, the Jaffe-Bechert rota-tor is still as popular as ever withphaco surgeons.

In this issue we will illustrate some ofthe instruments that have become themainstay for phaco surgery.

GLOBENEWS

VOLUME 11 NUMBER 1

FOR OPHTHALMIC PROFESSIONALS

atena introduces a new softIOL cutter for explanting lenses.It features a fixed lower blade

for insertion under the IOL and anupper movable blade for cutting sothat the blade movement can be visu-alized by the surgeon. The 6mm longblades have serrated edges to graspthe IOL surface and prevent it fromslipping away during cutting. Therongeur style mechanism provides

During his AAO 2000 presentationof “Surgical Technique Pearls forLASIK Enhancements”, Dr. Daniel S.Durrie of Overland Park, KSintroduced a new LASIK Flap Manipulator. It features a delicate,

olive shaped tip which is used togently depress the cornea to locatethe flap edge. Once located, Dr.Durrie engages the edge with thesmoothly polished tip and slides itaround the rim to partially open theflap. The flap is then lifted with a for-ceps to expose the stromal bed forlaser retreatment.Free technique video supplied with each instrument.

K3-2540

the strength to cut even the thickestsoft IOLs without twisting. Theround shank easily fits through a3mm incision. The instrument isoffered with two different handlemountings to suit the surgeon’s pref-erence. The vertically mounted handle ( K4-5571) points upward, inline with the blades, while the hori-zontally mounted handle ( K4-5570) is offset 90˚ to the right.

Flap Manipulator for LASIK Enhancements

K4-5570horizontal

handle

K4-5571vertical

handle (shown)

K3-2410

PHACO CHOICES

See Phaco Choices, page 3

K

Controlled IOL ExplantationKatenaSoft IOLCutter

Dr. Stephen P. Ginsberg of Kensington, Maryland hasdesigned a new speculum to address the problem of

redundant lid tissue and lashes entering the surgical field. Thespeculum features solid, non-reflective blades with flared ends to

control lid skin folds. The lower blade is shorter than the upper blade tofacilitate easy insertion and removal. Both blades are fenestrated tominimize pressure exerted on the globe. Strongly angled shanks allow theopening and closing mechanism to lie flat along the patient’s temple andcompletely out of the way.

Dr. Ginsberg states that this speculum is ideal for most ocular proceduresincluding laser and cataract surgery, as well as pterygium, strabismus,corneal transplant and posterior segment surgery.

Anew wire speculum has been designed by Stanley C.Grandon, M.D., of Dear-

born, Michigan. It features gentlycurled back tips to atraumaticallyretain redundant lid tissue. Theheavy gauge coiled fulcrumprovides strong spring tension tocompletely retract and control thepatient’s lids. Dr. Grandon usesthis speculum for both LASIK andcataract surgery.

K1-5679 Ginsberg Eye Speculum K1-5076Grandon Wire Speculum

r. Volker Rasch of Potsdam,Germany has designed aforceps for grasping and

stabilizing the Staar ® IOL cartridgewhile placing the IOL into thecartridge channel. The forceps(K5-8185) is designed to securelygrasp the rectangular holdingtab without blocking the surgeon’sview while placing the lens into theplastic cartridge.

The IOL LoadingForceps (K5-8184) isused to place the lensinto the open cartridge channel andfeatures concave tip surfaces forpushing the lens forward into thecartridge channel. The combinationof these instruments permits thesurgeon to comfortably work with45˚ hand positions.

K5-8185 Rasch Cartridge Holding Forceps

Dr. Frank Christensen of Chapel Hill, NC has developed a punch foropening a stenotic punctum. The punch features a thin tapered tip which canbe inserted into the punctum to excise a 1mm wide section of tissue in a singleaction. There is no need for multiple cuts, as with a scissors, therebyminimizing the amount of bleeding. The instrument can be used in theoffice or during DCR procedures for stenotic punctums.

K2-9525 Christensen Punctum Punch

controls redundant lid tissue

Ginsberg Eye Speculum

Helveston Fixation ForcepsRasch Cartridge

HoldingForceps

Grandon Eye Speculum

This new instrument was designed by Eugene M. Helveston,M.D., of Indianapolis, Indiana for fixating and retracting the globe during strabismus procedures. It has 0.6mm 1x2 teeth and athumb activated slide catch for locking. The instrument features a uniquecurved handle for stabilizing the forceps after affixing it to the globe.A suture may be placed through the hole in the end of the handle andattached to the drape for additional traction.

for globe fixation during strabismus procedures

for opening stenotic punctumsChristensen Punctum Punch

K5-8184

Staar ® is a trademark of Staar Surgical Company, Inc.

(Ref: “Ginsberg Lid Speculum provides a clear operating field”, Stephen P. Ginsberg, MD, Ocular Surgery News, March 15, 2001)

D

K5-2556 Helveston Fixation Forceps

The Lieberman MicroFinger fea-tures a curved, hourglass shaped tip for controlling, manipulating and cracking the nucleus duringphaco surgery.

Lieberman MicroFingerK3-2360 for use in right handK3-2361 for use in left hand

The double end Chang CombinationChopper features a modified Lieber-man MicroFinger and a pointedMaloney “quick chop” tip. TheMicroFinger tip is used for horizon-tal chopping of soft tomedium nuclei and the“quick chop” tip is usedfor vertical chopping ofhard nuclei.

The Dodick-Kammann Chopperwas designed for bimanual nucleuschopping. It features a 2mm long tipwith a wedge shaped inferior edgeand a smooth, rounded posterior tip.Using two of these instruments tochop the nucleus into small piecescan substantially reduce phaco time.

Dodick-Kammann ChopperK3-2384 straightK3-2385 angled

This instrument was designed forthe Fukasaku “snap & split” phacotechnique. The short, wedge shapedtip is used to crack the nucleus inthe “safe central area” while thesmoothly polished, notched superioredge is used to push back the iris forbetter visibility.

The multi-purpose Anis NucleusManipulator features a delicate ballshaped tip mounted on the end of acurved, thin shank, which is designedfor exerting counter pressure whilecracking the nucleus.

For the “divide and conquer” tech-nique, the Drysdale NucleusManipulator is preferred by manysurgeons. It features a smoothly pol-ished, paddle shaped tip, which isused to divide, split, and control the nucleus.

The Tennant Nucleus Manipulatorfeatures a ball shaped tip for rotatingand splitting the nucleus. The 0.6mm diameter ball tip is ideal forcontrolling soft nuclei.

For surgeons who prefer a singlehanded technique of cracking thenucleus, Katena offers the DodickNucleus Cracker with thin paddleshaped jaws. The longitudinal serra-tions on the outside surface of thejaws engage the grooved nucleus,while gentle pressure on thehandle opens the jaws tocrack it.

The Pisacano Nucleus Manipulatorfeatures a lightly concave, round shaftwith a 0.75mm wide disc shaped tipfor engaging the nucleus and guidingit toward the phaco probe. It is alsowell suited for the “divide and con-quer” technique.

Fukasaku Snapper HookK3-2393

Anis Nucleus ManipulatorK3-2426 straightK3-2427 angled

Tennant NucleusManipulatorK3-2428

The Ernest Nucleus Cracker featuresa patented cross-action mechanismwhich allows the surgeon to crack the nucleus through a 2.5mmincision without stretching thewound. Its delicate paddle shapedjaws have serrated outer surfacesto engage the nucleus and beveled corners for ease of extraction throughthe small incision.

Drysdale NucleusManipulatorK3-2418

Pisacano NucleusManipulatorK3-2420 horizontal flat tipK3-2421 vertical flat tip

The Knolle Nucleus Spatula fea-tures a 0.5mm wide, flat, stainlesssteel spatula which is completelymalleable. This allows the surgeonto angle or curve it to suit his or herpersonal preference.

With the Akahoshi Phaco PreChoppersculpting of the nucleus is eliminatedand phaco time is reduced. Afterinserting the sharp tipped jaws intothe core of the nucleus, the forcepshandle is gently squeezed to spreadthe jaws and divide the nucleus. Thepatented cross-action mechanismallows the jaws to fully open forcracking without stretching the smallincision.

choppers

manipulatorscrackers

Akahoshi PhacoPreChopperK5-7230

Rosen Phaco SplitterK3-2395 original modelK3-2396 60˚ model

The Rosen Phaco Splitter wasdesigned for the “phaco chop” tech-nique. It features a 1.1mm long blunttip with a blunt superior edge to pro-tect the capsule and a wedge shapedinferior edge for splitting the nucleus.The Rosen Splitter is also availablewith the wedge offset 60˚ for usethrough a paracentesis.

Chang Combination ChopperK3-2368 for use in right handK3-2369 for use in left hand

Knolle Lens Nucleus SpatulaK3-2350

Phaco Choices

Dodick Nucleus CrackerK5-7244

Ernest Nucleus CrackerK5-7240

Katena Products, Inc., 4 Stewart Court, Denville, NJ 07834 • USA / ☎973-989-1600 • 800-225-1195 • FAX 973-989-8175 • E-MAIL globe@katena.com • www.katena.com

4 Stewart CourtDenville, New Jersey 07834 • USA

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his lightweight aluminum case is ideal for sterilizing

and transporting 30-50 oph-thalmic surgical instru-ments. It features oneremovable upper tray anda large side compartmentfor handling bulkyitems. The upper andlower trays are lined

with soft silicone fingermats to securely hold and protectinstruments. For additional protec-tion of extra delicate hooks, manip-ulators and cannulas, an optionalrack insert is available.

r. Daniel B. Drysdale ofBlacksburg, Virginia hasdesigned a new 19 gauge

cannula (K7-5084) for closure ofclear corneal cataract wounds bypredictably pressurizing the eyeafter removal of all residual vis-coelastic. He attaches the cannulato the irrigation tubing with thebottle at maximum height (78cm).With irrigation on, the tip of thecannula is advanced to the inter-nal lip of the wound then slowlywithdrawn without hesitation.

K7-5084 Drysdale Closure Cannula

K9-2350 Sterilizing Case, doubleK9-2355 Instrument Rack (not shown)Outside dimensions: 123⁄4'' x 10 1⁄2'' x 1 5⁄8''

(325 x 265 x 42mm)

T D

Dr. Drysdale suggests that the sur-geon’s first few cases be closed inthe usual manner, and thatTonoPen® pressure be taken with asterile tip cover in place just beforeand after pressurizing with theDrysdale Closure Cannula. Oncethe results are acceptable, occa-sional post-op tonometry may beperformed in complicated cases orwhen wound competence is inquestion for any reason.

www.katena.com

Double Sterilizing Case