OPHTHALMOLOGIC TOOLS (ustar. eye tools) — the special tools applied in an ophthalmosurgery. The first tool for extraction of a cataract was offered in 1745 by J. Daviel. Further tools for operations on an eyeglobe were borrowed from the general surgery. Special O. and. appears to the middle of 19 century in connection with development of surgery of an eye. Creation and its improvement went in parallel with development ophthalmology (see) also it is connected with names of the largest domestic and foreign ophthalmologists. So, A. Gref in 1857 — 1867 designed cataract linear knives, capsulotomes (cystotomes), a fixation forceps, the scarificator, blefarostat, a hook for an iris, etc. Many tools are created by Eger (F. Jaeger), L. de Wecker, Aksenfeld (Th. Axenfeld), A. Elschnig, etc. Powerful contribution to O.'s development and. domestic scientists A. G. Agababov, L. G. Bellyarminov, M. M. Voinov, S. S. Golovin, V. P. Filatov, etc. brought; in 1924 A. P. Martsinovsky designed the trepan intended for trepanation of cataracts in 1948 by B. L. Polyak the probe for the nasolacrimal channel, sklerometr is offered; in 1951 B. L. Radzikovsky offered corneal tweezers.
In the mid-sixties developed 20 century O. and. for eye microsurgery, in development the cut a big role was played by M. M. Krasnov.
A number of requirements connected with features of microsurgeries is imposed to oftalmomikrokhirurgichesky tools (see. Microsurgery ), in particular to their size, the size of a working part, a form, materials, from to-rykh they are made, to a covering etc. The size of tools for these operations was reduced to 60 mm, a working part of cutting instruments decreased to 1 — 3 mm, and at tweezers and nek-ry scissors — to shares of millimeter. Tools are manufactured of stainless steels or titanium alloys, their cutting part — of the carbon steel capable to be exposed to a hardening and to get at the same time high hardness. Nek-ry working parts of tools have a diamond dusting that increases their hardness and extends the term of operation of the tool.
In the USSR the St. 250 names of ophthalmologic tools are issued. Nek-ry O. and. it is completed in sets.
Lake and. depending on range of application subdivide into the tools of general purpose used during the carrying out the majority of eye operations and on special for performance only of nek-ry operations — concerning glaucoma, a cataract (tsvetn. fig. 1 — 9), amotio of a retina, a keratoplasty, etc. On the nature of use allocate the tools intended for expansion of a palpebral fissure and wounds and keeping a century in a patency; fixing; cutting and pricking; auxiliary, intended for special operations and manipulations.
Tools for expansion of a palpebral fissure and wounds — blepharostats, eyelid lifters, ranorasshiritel, hooks; Demarr's eyelid lifters with the bent plates wide kryuchkoobrazno with saddle dredging (fig. 1) are most widespread. Eyelid lifters with a mobile mirror and the eyelid lifters with a working part from plexiglas connected to the light guide that allows to carry out local integral lighting in an operational wound are the most widespread. Use eyelid lifters both for a raising a century, and for their so-called double ectropion for the purpose of survey of all surface of an upper fornix conjunctiva. At operations on an eyeglobe for expansion of a palpebral fissure and deduction a century blepharostats (blefarostat) of various designs serve. The rack blepharostat with a support on a ridge of the nose and a temple has a removable support of a ridge of the nose that does it universal for the right and left eye (fig. 2). At a small palpebral fissure the so-called triple blepharostat (fig. 5) is convenient, in Krom there is the third hook for procrastination of an outside corner of a palpebral fissure. Use also blepharostats screw (fig. 3) and wire Barrakera (fig. 4), and also spring, horseshoe, etc. During operation (through change of a cornea, etc.) apply eye rings, or rings of Fliringa (fig. 6) to fixation of an eyeglobe, to-rye hem to a sclera. At operation of a paracentesis by means of the eye fixer (fig. 12) the eyeglobe is fixed in surface layers of a sclera. Ranorasshiritel are applied to cultivation of edges of skin wounds: Müller (fig. 11) — for plastic surgeries, Finsen — for operation on a dacryocyst (fig. 10) and micro-ranorasshiritel (fig. 9). For keeping of edges of a wound use chetyrekhzuby sharp retractors, for capture and removal of an iris — stupid and acute iris hooks (fig. 7), for drawing apart edges of a wound on centuries — bidentate sharp retractors (fig. 8). Also hooks for a cornea, for eye muscles, a fenestrated tenaculum for eye musles, etc. are used.
The fixing tools are presented by clips and tweezers. Apply a direct styptic clip (fig. 13) and a clip with a tooth to a stop of bleedings (see. Clips surgical ); for fixation of an eyeglobe during an operative measure — gear surgical tweezers (fig. 26) fixing tweezers with the expanded termination and a large number of teeth (fig. 15) and sometimes supplied with the spring lock (after Gref). At plastic surgeries use tweezers for fixing of an upper direct muscle of an eye (fig. 14). For operations with magnetic foreign bodys non-magnetic tweezers are issued; for operations on centuries at expression of trachoma grains — a fenestrated forceps of Bellyarminov (fig. 24). At operations on centuries for removal of chalazion use tweezers on Demarra (fig. 25), with the help to-rykh fix and straighten an eyelid, and for capture of a transplant from a mucous membrane of a lip — a fenestrated forceps of Israelson (fig. 23). Are applied as well other eye tweezers (see).
The size of a working part at oftalmomikrokhirurgichesky tweezers is significantly changed. E.g., length of a working part of a curved and straight microsurgical mouse-tooth (flat) forceps of 6,5 mm, and width of 0,5 mm (fig. 19); width of working part one - bidentate microsurgical tweezers of 0,3 mm, and height of a tooth is 0,14 mm (fig. 17); the corneal ophthalmic forceps height of a tooth has only 0,1 mm. Multi-purpose oftalmomikrokhirurgichesky tweezers is the pointed microsurgical forceps (fig. 18), the microsurgical tweezers on Bar-rakeru (fig. 20) are widely applied. For removal of intraocular foreign bodys use tweezers with the usual ends (fig. 21) and collet (fig. 21, I); similar tweezers with a cannula allow to support at the same time the stable intraocular pressure (fig. 22). Also special microsurgical tweezers are applied to an iris of the eye (fig. 16), corneal („humming-birds") for a keratoplasty — direct and curved, etc.
The cutting and pricking tools are presented by various knives, scalpels, scissors, needles, trepans, chisels, loops, spoons, curettes, vykusyvatel, etc.
Averages and small bellied scalpels are applied to skin cuts, handles to-rykh are often manufactured of titanium alloys. Cataract linear small, average and big knives, and also lanceolated knives of Eger — direct and curved, poorly curved, small and big, etc. are intended for cuts on an eyeglobe (see. Knives surgical ).
As microsurgical cutting instrument shaving edges or their pieces and a lezviyederzhatel across Kastrovyekho — are used direct (fig. 39, 40) and curved (fig. 41). Surface of a lezviyederzha-tel corrugated or opaque.
Knives — eye discission (45), eye microsurgical (46), with a diamond dusting are applied to microsurgeries. In a refraction kera-tokhirurgiya use a crescent microsurgical knife according to Sato (fig. 47), to-ry also found application at operations on an iris of the eye, in an anterior chamber, in a vitreous. Stratifying of a cornea at a layer-by-layer keratoplasty make knives Puchkov-sky (fig. 48), having rounded shape and various degree of a bend. For a section of back synechias the left and right synechiotomes on Aksenfelda (fig. 60) are used. Removal of a subdislocated or dislocated crystalline lens is carried out lenticular loops according to Weber and loops with a crosspiece (fig. 56, 57). At evisceration of an eyeglobe the wide flattened spoon is applied to removal of contents of an eyeglobe across Bunge (fig. 42). Chalazion delete with cyclodialysis acute spoons — big (fig. 43) and small (fig. 44); lenticular weight — spoons across Daviel and after Gref. In an ophthalmosurgery use also eye spoon curettes of 3 sizes.
The big and various group of cutting instruments is made by oftalmokhirurgichesky and mikrooftalmokhirurgichesky scissors. Conjunctival cuts make vertically curved sharp-pointed and blunt eye scissors, corneal cuts — corneal vertikalnoizognuty blunt scissors. Scissors for a vitreous have the extended narrow edges slightly bent down (fig. 49). At scissors for enucleation of an eye (fig. 50) of an edge short, curved down. In an ophthalmosurgery also scissors are used to a section of front synechias of an iris of the eye, scissors for a cornea, etc. (see. Scissors surgical ). Corneal spring left and right scissors (fig. 53) belong to a microscissors. At antiglauko-matozny operations a microscissors is applied to a sinusotomy; they differ in the small sizes of the cutting part and the acute ends. For a vyku-syvaniye of the site of a sclera or formation of an opening in a thick film in the field of a pupil the spring vykusyvatel is intended for a sclera (fig. 27). At corectomy use Vekker's (fig. 54) scissors tweezers with straight lines and the cutting branches bent across. Eye spring scissors across Vannas (fig. 51), etc. enter into group of a microscissors for an iris. Scissors with a cannula — straight lines (fig. 52, 52, a) are used to intraocular microsurgeries and curved (fig. 52,6). Use also pivotally-polzunnymi rotary scissors for a sphincter of a pupil, the left and right spring scissors for a shlemmov of the channel, spring scissors for a sclera, etc.
Foreign bodys delete from a cornea by means of a lanceolated needle (fig. 32), to a section of a front bag of a crystalline lens and secondary cataracts apply discission needles (fig. 31), and to a tattoo of a cornea — Bellyar-minov's needle (see. Eagles medical ). At suture for formation of an anastomosis between a dacryocyst and a nasal cavity use stupid ligature needles for the lacrimal channel (fig. 35). For imposing of surgical seams atraumatic needles are most widespread in an ophthalmosurgery, with the help to-rykh the best sealing of wounds and cuts is created. Atraumatic eye needles have the flat section and cutting edges. Length of needles for a usual ophthalmosurgery of 7 — 9 mm, for microsurgery of 4 — 5 mm.
Apply needles with a thickening in 15 mm from an edge (fig. 33) connected to the syringe to suction of a vitreous and a spoon (fig. 34). The flat cannulas which are put on or directly on the syringe, or through a lengthening tube (fig. 36) are intended for administration of air in an anterior chamber; also flat microsurgical cannulas are issued.
Also the cannula spoon (fig. 38), the end a cut is applied to removal of foreign bodys it is funneled it is expanded and bent at right angle. The cannula for suction of the lenticular masses (fig. 37) is flattened in section that allows to suck away the lenticular masses crushed during the washing. The lacrimal ways wash out by means of direct, curved and slaboizognuty cannulas.
For capture of a transplant of a cornea of the donor and the recipient at a keratoplasty FM-3 and FM-4 trepans are intended for a subtotal keratoplasty (fig. 61, 62), and for trepanation of a sclera at antiglauko-matozny operations — Elliot's trepans for corneoscleral trepanation (fig. 63). At operations on the shlemmovy channel go-niotom (fig. 28), the left and right dilators of a shlemmov of the channel together with the left and right trabekulo-volume and the double probe of Kharms (fig. 29) are applied — one of branches of the probe is entered into a gleam of the channel, the second serves for control of carrying out.
At operation of extraction of a cataract for assignment of an iris of the eye use the retractor of an iris of the eye (fig. 58), and at scleral operations — the retractor with replaceable heads (fig. 59).
3 dolotets enter tool kit of Shotter for removal of foreign bodys from a cornea, the ends to-rykh have various form and the sizes allowing conveniently with the minimum traumatization to take foreign bodys. Besides, the special chisel is applied to these purposes.
Accessory and some other instruments. Eye pallets — non-magnetic unilateral and bilateral (fig. 82), flat and zhelobovaty treat accessory instruments. The special pallet is used to a cyclodialysis, and for stratifying of a sclera use the elastic pallet with keen edges (fig. 83). The microsurgical curved pallet No. 1 (fig. 84) and No. 2 is used to microsurgical manipulations, at operations on centuries — a plate of Eger — Rabinovich (fig. 78).
For keeping of needles with a radius of 10 mm and more Zand's (fig. 69) needle holders and Filatov's needle holder with the fixer for a finger (fig. 70), for smaller needles (4 — 7 mm) — microsurgical needle holders across Kastrovyekho (fig. 72) or on Barrakera (fig. 71) — with the lock or without lock serve. Working parts of needle holders often have a diamond covering. The unit clamp is applied to deduction of an eye ligature.
For intrakapsulyarny extraction of a crystalline lens cryoextractors serve: eye piston (fig. 76), filled by dry ice, and the rod (fig. 77) connected through a reducer to a cylinder with liquid carbonic acid and also the prisasyvayushchy tool for removal of a crystalline lens in the capsule (Erizofak, fig. 74).
On an eyeglobe are used the eye measuring instrument (fig. 73) with a limit of measurement to measurements from About to 16 mm and sklerometr (fig. 80) with a limit of measurement from 10 to 25 mm. At operations on direct and oblique muscles of an eye use the tool with a measuring scale.
At manipulations on the lacrimal ways various probes are used: for expansion of the lacrimal openings at their stenozirovaniye or before washing of the lacrimal ways — conic probes of three sizes for the lacrimal tubule (fig. 66); for expansion of the nasolacrimal channel — cylindrical two-sided probes, or Boumen's (fig. 67) probes consisting of two probes connected by a figured plate are specified a cut their numbers (before sounding probes are given slightly the arc-shaped form). At recovery operations on the lacrimal tubules use the probes conductors of 3 sizes for carrying out thread (fig. 68) offered by V. N. Alekseev. The probe has a working part of the right and left execution. At operation of a dacryocystorhinostomy the nasolacrimal channel is probed thicker cranked probe of Weber having olivarian thickenings on the ends. Probes carry out through a section of a front wall of a dacryocyst. At outside approach (transkutanno) apply cylinder-shaped cutters (fig. 81) to formation of a bone opening, to-rye are set in motion by means of the handle for fixing of mills at operation of a bezmolotkovy dacryocystorhinostomy (fig. 79).
For decrease in intraocular pressure, at inflammatory processes in a front piece of eyes, at operations for peeling of a mesh cover and in other cases cryocauters (fig. 75) similar on a design to cryoextractors, both single-pole and bipolar diatermokauter (fig. 65) are successfully applied.
The hemostasis at microsurgeries is usually made a galvanocauter (fig. 64).
At operations for glaucoma Krasnov's gonioscopy lenses intended for carrying out operations in the field of a corner of an anterior chamber of an eye are applied.
Sets of oftalmokhirurgichesky tools. In the USSR is issued apprx. 20 sets O. and. In their structure it is switched on St. 150 modern tools, from to-rykh St. 100 20 century are developed in the 70th, St. 50 — it is modernized. So, the tool kit for eye microsurgery contains 75 tools (blepharostats, knives and scissors, tweezers, dilators of a shlemmov of the channel, scarificators, trabekulotoma and pallets, etc.); in set for operations for glaucoma 72 tools (blepharostats, a vykusyvatel for a sclera, a goniotom-cannula with adjustable supply of liquid, gonio a lens, needle holders, knives and scissors, scarificators of 4 sizes, synechiotomes, tra-bekulotoma, trepans and pallets, etc.); in set for operations for a cataract of 70 tools (blepharostats, needle holders, cannulas, capsulotomes, rings eye, hooks, spoons for lenticular weight, knives and scissors, tweezers, loops lenticular, synechiotomes, etc.); in set for operations for amotio of a retina 61 tools (needle holders, needles for a sclera, cannulas, clip-on earrings eye, knives, scissors, tweezers, scarificators and pallets, etc.), in set for a keratoplasty of Filatov — Martsinkovsky of 12 tools, including round knives, obturators, trepans, the pallet for a transplant.
Besides, sets are issued: for removal of foreign bodys from an eye (52 tools), for operations for squint and removal of an eyeglobe (38 tools), for eye out-patient operations (56 tools), etc.
Table. SOME TYPES of OPHTHALMOLOGIC TOOLS
The name of tools and their appointment (in brackets number of the drawing is specified). Total length (L); sizes of a working part: &dlinanbsp; (I), width (b), &diametrnbsp; (d), radius (r)
Tools for expansion of a palpebral fissure and wounds
The fixing tools
The cutting and pricking tools
Accessory and some other instruments
Bibliography: Krasnov M. M. Microsurgery of glaucomas, M., 1980; Kowalewski. E. I. and Tyshkov-s to and y JI. AA. New sets of tools for the general and microophthalmosurgeries, Vestn, oftalm., No. 1, page 73, 1976; Microsurgery of an eye, under the editorship of M. M. Krasnov, page 14, M., 1976; The Multivolume guide to eye diseases, under the editorship of V. N. Arkhangelsky, t. 4, page 12, M., 1959.
G. A. Sokolovsky.