%0 Journal Article
%T Intraocular Microsurgical Forceps (20, 23, and 25 gauge) Membrane Peeling Forces Assessment
%A Raul Velez-Montoya
%A Chirag Patel
%A Scott C. N. Oliver
%A Hugo Quiroz-Mercado
%A Naresh Mandava
%A Jeffrey L. Olson
%J Journal of Ophthalmology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/784172
%X Background. To assess the peeling forces exerted by different calibers of microsurgical forceps on an experimental model of epiretinal membrane. Methods. A model of epiretinal membrane was constructed using thin cellulose paper and heptanes-isopropyl alcohol 1% mixture. The model was mounted on a force censoring device. Subsequently, flaps were created with three different microsurgical forceps of different calibers. We recorded the number of attempts, the duration of the event, and the pushing and the pulling forces during the peeling. The results were compared by a one-way ANOVA and a Fisher unprotected least significant difference test with an alpha value of 0.05 for statistically significance. Results. There was a statistical significant difference on the pulling and pushing forces between the 25 gauge (13.79£¿mN; £¿13.27£¿mN) and the 23 (6.63£¿mN; £¿5.76£¿mN) and 20 (5.02£¿mN; £¿5.30£¿mN) gauge, being greater in the first ( ). There were no differences in the duration of all events, meaning that all the forces were measured within the same period of time. Conclusions. The 25 gauge microsurgical forceps exerted the greatest mechanical stress over our simulated epiretinal membrane model and required more attempts to create a surgical suitable flap. The clinical implication of this finding is still to be determined. 1. Introduction The surgical resolution of vitreoretinal diseases involves the micromanipulation of very fragile structures. A successful surgery depends upon the surgeon possessing a particular set of skills that include precise manual dexterity, fine visual-motor coordination, and improvisation capabilities, acquired after long hours of training [1, 2]. Imprecise movements due to tremor, poor visibility, and fatigue often may result in tissue damage which can be irreversible and sight-threatening depending on location [3, 4]. Macular surgery is one such scenario in which external factors (patient movements and surgical instruments), along with the surgeon¡¯s dexterity, may influence the outcome [5]. Macular hole (MH) repair, epiretinal membrane (ERM), and internal limiting membrane (ILM) peeling are perfect examples where the application of unknown forces to the tissues may lead to hemorrhage, tearing, and potential irreversible visual loss [5¨C7]. With the introduction of minimally invasive surgical techniques (23 and 25 gauge vitrectomy), macular diseases are addressed surgically more often and earlier than ever [5]. Along with the change in surgical paradigm, several aspects of retinal instruments have undergone further refinement [8, 9].
%U http://www.hindawi.com/journals/joph/2013/784172/