Hideyuki Futamura

Sutureless contact lens ring system during vitrectomy

PURPOSE To report a new sutureless ring system to fix corneal contact lens in place during vitrectomy. DESIGN New surgical instrument. METHODS The sutureless ring system consists of a stainless steel ring that has two upright tabs 180 degrees apart with a hook on the top and two elastic silicone bands 8 mm in diameter to fix the ring to the eyelid speculum. RESULTS The contact lens fixed in place with the sutureless ring was stable and allowed intraoperative visualization of the fundus. CONCLUSION This suture-free contact lens system facilitates visualization of the fundus during vitrectomy allowing shorter surgical time. It also enables us to avoid additional trauma associated with the lens ring fixation procedure.

Combining a contact lens and wide-angle viewing system for a wider fundus view.

Combining a Contact Lens and Wide-Angle Viewing System for a Wider Fundus View The use of wide-angle viewing systems during vitrectomy has gained in popularity because surgeons can see a wide fundus area simultaneously and can correctly evaluate the pathogenesis during surgery. The usefulness of these systems is more important during microincision vitrectomy surgery, in which a 25or 23-gauge system is used without a conjunctival incision because it is difficult to indent the sclera to see the far peripheral retina. Two types of wide-angle viewing systems, the contact lens system and the noncontact lens systems, are available; each has advantages and disadvantages. A disadvantage of the noncontact lens system is corneal surface drying, which results in a blurred fundus view. Surgical assistants periodically irrigate the corneal surface with water, although the use of a viscoelastic material on the corneal surface may decrease the need for frequent irrigation. Water droplets may come into contact with the lens surface, which also reduces the quality of the surgical field view. We report the usefulness of combining a wide-angle viewing system and a magnifying contact lens to provide a wider fundus view without the help of a surgical assistant.

Magnifying Prismatic Lenses for Vitrectomy

PURPOSE Viewing the fundus at higher magnification during vitrectomy makes surgical procedures much safer; however, the scope of magnification of the peripheral fundus has been limited. For better visualization of the periphery of the fundus, we have developed two new contact lenses called magnifying prismatic lenses. METHODS The magnifying 15 degrees and 30 degrees prismatic lenses are made of a glass with a high index of refraction (n = 1.883). The lenses have a convex upper surface to provide a magnified view of the peripheral fundus. RESULTS These magnifying 15 degrees and 30 degrees prismatic lenses provide an approximately 2x magnified view of the peripheral fundus. They also provide a more extensive view of the peripheral fundus than a regular (plano-concave) prismatic lens when the eye is tilted. CONCLUSION The magnifying prismatic lenses are useful for viewing into the peripheral fundus with higher magnification.

New sutureless contact lens ring system for vitrectomy using cannula system.

Although wide-viewing systems are commonly used during vitrectomy, conventional floating contact lenses are still used especially during macular surgery because they provide a clearer view and better stereoscopic images. Two types of lens ring systems are used with the planoconcave floating lens during vitrectomy; one is the conventional lens ring sutured to the sclera, and the other is a sutureless contact lens ring system. Although the former provides secure fixation of the ring to the eye, the suturing procedure is time consuming and bleeding frequently occurs. In addition, with the spread of transconjunctival sutureless vitrectomy using 25-gauge or 23-gauge instruments, the development of a lens ring system that can preserve the conjunctiva with easier fixation procedures would be desired. The sutureless contact lens ring system was developed to meet such a need. The lens ring is fixed to the eye by two silicone bands, which are hooked to a lid speculum. The procedure is simple and easy; however, a good central fixation of the lens ring is sometimes difficult during rotation of the globe or during vitrectomy for deep-set eyes or eyes with asymmetrical lid opening. These disadvantages are caused by the method of fixing the lens ring to the lid speculum. To overcome these difficulties, we have developed a new sutureless lens ring system that can be fixed not to a speculum but to the globe by a silicone band that is hooked to the two cannulas used during microincision vitrectomy.

Disposable eyelid speculum designed for intravitreal injection.

Intravitreal drug injection has been increasing dramatically. The antivascular endothelial growth factor drugs, which are used as the firstline treatment for wet age-related macular degeneration, require repeated injections to maintain their effectiveness. The injections are usually administered in the office to avoid missing the best treatment interval. Endophthalmitis is rare, but it is a serious complication after intravitreal injection. The major cause is considered to be the bacterial contamination from the ocular surface, eyelids, or eyelashes via the injection needle. Meticulous draping of the eyelids may reduce the risk of endophthalmitis, but that is not realistic because of the large number of intravitreal injections administered. Actually, some cases of endophthalmitis were associated with the failure to use an eyelid speculum. We introduce a new disposable plastic eyelid speculum EzSpec (Hoya Corporation, Tokyo, Japan) with broader plates holding the eyelids to facilitate intravitreal injection.

Technique to alter field of view during vitrectomy with phacoemulsification and aspiration in gas-filled eye

PURPOSE To describe a method to alter the angular field of view of the fundus in gas-filled eyes during pars plana vitrectomy and phacoemulsification with aspiration and intraocular lens implantation. v Description of a new surgical method. METHODS The amount of viscoelastic material injected into the capsule is regulated, altering posterior capsule curvature. RESULTS The visual field can be varied from 5 to 108 degrees. Surgery on more than 300 eyes with rhegmatogenous retinal detachment and cataract using this technique has been successful with no complications. CONCLUSIONS This method effectively controls the field of view in gas-filled eyes.