New drape speeds ophthalmic surgery

Surgical draping for ophthalmic surgery has never been quick or easy-until now. A new drape design allows the surgeon or scrub nurse to fully drape the patient in seconds.       

“Even after meticulous cleaning of the lids and conjunctival sac before surgery, there is still a risk of contamination of the surgical field by the bacteria on the eyelashes and the Meibomian secretion,” said Takayuki Akahoshi, MD, director of ophthalmology at Mitsui Memorial Hospital, Tokyo. “Appropriate draping to cover the eye lids and lashes completely and blocking the meibomian secretion is extremely important for the prevention of endophthalmitis. But traditional draping is time- and labor-intensive. So we developed an alternative.”      

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Dr. Akahoshi described his novel surgical drape during the 2016 American Society of Cataract and Refractive Surgery (ASCRS) Symposium and Congress. The new design allows for faster draping, which helps him to perform 10 to 12 cases per hour. In 2015, he performed nearly 10,400 

Two conventional drapes

There are two conventional drapes in common use, Dr. Akahoshi explained, and both pose significant barriers to efficient, painless surgery.

One drape has a single window cut into the blue cover material but has no adhesive materials. The surgeon must cut adhesive sheets such as Tegaderm to fix the upper and lower lid.

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The other drape has an adhesive sheet affixed to the blue cover material. Once the adhesive layer is placed over the eye, the surgeon must cut the sheet along the lid in order to place the speculum. The scissors or other cutting instrument could damage the cornea.

The new drape has an adhesive patch fixed to the blue cover material with a pre-cut slit. The drape and adhesive is folded in a manner that allows it to be opened quickly and easily over the patient’s face with both the upper and lower lids and lashes completely covered. Dr. Takahoshi has applied for a patent on the new drape design.

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“It only takes ten seconds to drape the patient, something the scrub nurse can do as part of the general preparation,” Dr. Akahoshi explained. “And we minimized the stickiness of the adhesive to ensure that the patient does not feel any pain or pulling of the eyelashes when we remove the drape at the end of the surgery.”

Speed and ease of draping and undraping are only two advantages of the new system, he continued. The drape is manufactured with a second window that covers the non-operative eye. The second window remains closed for most patients. But it can quickly be opened for patients who feel anxious or claustrophobic when fully draped.

Second window

“I have seen many patients who were afraid to cover their entire face during surgery, so I had to use scissors to open a second window so they could see during surgery,” Dr. Akahoshi said. “That simple modification made almost everyone more comfortable during surgery, so I added a second window that can be opened very easily if needed.”

The second window is also useful in fixing the operative eye. It can be difficult to fix the eye for some patients because the operative illumination is so bright, Dr. Akahoshi said. Because there is no illumination in the second window, it is easier to direct the patient to direct the gaze to the proper position.

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The second window also helps when operating on children or other patients who might have problems affixing their gaze. Opening the second window allows the surgeon to position a blinking light or some other visual beacon for the patient to focus on, which helps stabilize the operative eye without having to adjust the drape during surgery.The new drape is also more effective in maintaining a clean surgical field. Eyelashes often escape traditional drapes, Dr. Akahoshi explained, which can obscure the surgical field.

In cases where the drape does not completely cover the eyelid margin, the oily layer of meibomian secretion on the cornea hinders visibility inside the eye. The surgical assistant can attempt to wash away the oily layer and floaters, but washing often causes the patient to blink, which interferes with the procedure.

Covering eyelashes

“The new drape can cover the eyelids completely to enclose the eyelashes and prevent the meibomian secretion, leaving a wide and uniformly clean surgical field,” Dr. Akahoshi said. “This allows the surgeon to concentrate on the surgery more fully and more comfortably. By blocking the contaminated meibomian secretion, the new drape helps to diminish the risk of endophthalmitis. In the 15 years we have used this type of drape, we have not encountered any bacterial endophthalmitis at all.”

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The new drape is no more expensive than conventional drapes, he added, and is easier for scrub nurses and other assistants to place and to remove.

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“This new drape is extremely easy to use and provides an improved surgical field,” he said. “It will prevent contamination of the surgical field and can prevent endophthalmitis due to contamination. And because it reduces the preparation time, it can increase the number of surgeries you can perform in the same time period.”

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Dr. Akahoshi reports no financial interests the products detailed in this article. Product prototypes were produced courtesy of ASICO.