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Volume 1 -  Instruments Used for Strabismus Surgery Lecture 2 of 24  NEXT»

The design of the instruments used for strabismus surgery which you are using, particularly the muscle hooks, may be more than 100 years old. But strabismus surgical techniques have evolved, as would be expected, and these changes have created the need for instrument modification. This has resulted in the design of new 12 mm, 10 mm, and 8 mm muscle hooks which are the principal hooks used for strabismus surgery. They have a finer shank which allows suture placement behind the hook providing greater security of the suture - muscle attachment - while minimizing the chance of muscle slippage in the capsule. The resection effect provided is minimal and is consistent.

1

The small
"resection effect
is negligible"
 

 

8 mm

10 mm

12 mm 

3

2 

 

8mm Small Finder

12 mm Large Finder 

Large and small "finder hooks" which have an upturned and moderately pointed tip are useful when a muscle is to be hooked initially and the hook replaced by a second hook as is often done during reoperation. The fine tip on this hook allows it to be removed without tissue "hanging-up." The finer tip also enables the hook to be used for dissection in reoperation. Be careful with these hooks! The sharper tips on the finder hooks which enable them to help you dissect scarred tissue could also cause perforation of sclera if excess force is applied to the hook causing it to penetrate the sclera wall.

4The 5mm "teaser" hook is an all purpose utility type hook. It can be used in localizing the inferior and superior oblique and for a variety of other tasks. This hook is also used for clearing the tips of the two hooks holding the rectus muscle when using the fornix incision.

5 mm

The "Barbie" retractor is an all purpose tool to help with exposure. The thinner design is more user friendly than the thicker, more curved Desmarres retractor. The "Barbie" retractor comes in three sizes: the standard 7mm, the "Big Barbie" 9mm and the "Great Big Barbie" 11mm.

Great Big Barbie     Big Barbie     Barbie 
5
           11 mm              9 mm             7 mm

6The new tying forceps #18 are delicate and user friendly.

7A scleral ruler is particularly useful when measuring from the limbus or when doing a posterior fixation suture. A small pointed tip on the underside of the ruler enables safe marking in the sclera producing a "blue dot" which remains for sufficient time to help with accurate muscle reattachment. This instrument is a slight modification of the (William) Scott ruler.

 

 

 

A modification of the curved moody castrovielo locking provides more security as well as a self retaining feature.

8

The instrument set shown including several newly designed instruments will be adequate for doing nearly all strabismus procedures. When other instruments, such as the tucker, resection clamp, etc., are needed they can be obtained from the "wrapped" sterile instrument supply. Each surgeon will develop her/his preferred instrument set. The set shown is a good beginning.

9

A BASIC INSTRUMENT SET FOR STRABISMUS SURGERY

1) 1 ea. K 1-5678 Lieberman Speculum Solid

2) 1 ea. K 1-5677 Lieberman Speculum Solid Sm

3) 3 ea. K 5-4320 Lester Fixation Forceps 2x3

4)* 1 ea. K 5-2554 Moody Fixation Forceps Right

5)* 1 ea. K 5-2553 Moody Fixation Forceps Left

6) 1 ea. K 5-2020 Bonn Forceps Long 0.12mm

7) 1 ea. K 3-6778 Helveston Muscle Hook 8mm

8) 1 ea. K 3-6780 Helveston Muscle Hook 10mm

9) 1 ea. K 3-6782 Helveston Muscle Hook 12mm

10) 3 ea. K 3-6610 Helveston "Teaser" Hook 6mm

11) 1 ea. K 3-6760 Helveston Finder Hook Large

12) 1 ea. K 3-6761 Helveston Finder Hook Small

13) 1 ea. K 1-9010 Helveston "Barbie" Retractor

14) 1 ea. K 1-9012 Helveston "Big Barbie" Retractor

15) 1 ea. K 1-9019 Helveston "Great Big Barbie" Retractor

16) 1 pk. K20-1690 Miniature Blade #69 (pk/6)

17) 1 ea. K 7-5000 Bishop-Harmon A/C Irrigator

18) 2 ea. K 5-5420 Helveston Tying Forceps Straight

19) 1 ea. K 6-1560 Castroviejo Ndl holder Straight W/L

20) 1 ea. K 6-3520 Barraquer Ndl Holder CVD W/L

21) 1 ea. K 4-3004 Westcott Tenotomy Scissors Medium

22) 1 ea. K 4-4100 Westcott Stitch Scissors

23) 1 ea. K 3-9000 Castroviejo Caliper Straight

24) 1 ea. K 3-9030 Helveston Scleral Ruler

25) 2 ea. K 5-9850 Serrefine Small Straight

26) 2 ea. K 5-9910 Hartmann Mosquito Forceps CVD

 

Each surgeon will have his or her own preferences and will modify the set shown above accordingly. Any type of strabismus surgery can be done with the set as is, but some surgeons prefer to use resection clamps, tendon tuckers, square green hooks, etc. which could be added to "flesh out" the basic set. This instrument set is available from Katena Products, Danville, NJ, USA, phone (973) 989-1600. The authors have no proprietary interest.

* These may be replaced by two curved Helveston modifications of the "moody curved locking castroviejo forceps".

The Strabismus Minute, Vol.1, No. 6 Copyright (C) 1999 Eugene M. Helveston All Rights Reserved

Editor-in-Chief: Eugene M. Helveston, M.D.

Associate Editor: Faruk H. Orge, M.D.

Editorial Board: Bradley C. Black, M.D.

Edward R. O'Malley, M.D.

David A. Plager, M.D.

Derek T. Sprunger, M.D.

Daniel E. Neely, M.D.

Naval Sondhi, M.D.

Senior Editorial Consultant: Gunter K. vonNoorden, M.D.

Graphics: Michelle L. Harmon

Technical Support: George J. Sheplock, M.D.


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