Novel forceps design improves iris hook placement

Take-home message: New forceps designed by Lawrence Goldberg, MD, improve the technique for iris hook placement due to two-point fixation.

Reviewed by Lawrence Goldberg, MD

Saint Petersburg, FL-Flexible iris hooks, used as adjunctive devices during cataract surgery in eyes that have poorly dilating pupils and/or floppy iris syndrome, occupy a narrow but important niche in the armamentarium of surgical accessories.

However, that does not rule out the possibility of improvement in the technique of their placement.

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Lawrence Goldberg, MD, who practices in Saint Petersburg, FL, has designed an instrument (Goldberg Iris Hook Forceps, Rhein Medical) featuring two-point fixation to improve surgical maneuverability.

Physicians typically use tying forceps to insert iris hooks, but in Dr. Goldberg’s experience, it is difficult to grasp the hooks and keep them stable. This is primarily due to one-point fixation and lack of a gripping surface on currently available tying forceps.

Two-point fixation

The new forceps grasps the hook around the adjustment ring at two points on either side of the shaft.

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“You can hold it and manipulate it quite easily because of two-point fixation,” he said.

The instrument is typically able to grasp the hook directly from its holding case. However, a standard tying forceps may be used to hold or adjust the hook for initial placement in the jaws of the new forceps, Dr. Goldberg said.

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Usually a standard tying forceps is only needed to adjust the hook’s silicone sleeve so the pupil enlarges to the desired size, while the end of the hook is held immobile by the iris hook tool’s distal jaw.

Designing a new tool

Designing a new tool

When experimenting with a new tool for use with iris hooks, Dr. Goldberg first designed one with a groove at the end of the tool's two jaws but discovered that it was difficult to grab the hook evenly on both sides. His solution was to use an undulating gripping surface on both jaws so that the instrument could be placed more precisely around the hook and hold it more securely than a standard tying forceps with a smooth surface.

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In a procedure, such as small pupil pseudoexfoliation cataract surgery, which, according to Dr. Goldberg, is well suited to the use of iris hooks, the new tool can improve surgical proficiency. Dr Goldberg especially advocates iris hook placement in any small pupil or floppy iris case associated with a shallow anterior chamber, since the other available iris expansion devices present a larger profile in a tight space.

Except for surgeons who perform a high volume of cataract procedures, most will infrequently encounter cases where iris hooks could be beneficial and thus, lack the opportunity to hone their skills.

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In addition, all irises are not in the same position, and factors such as the edge of the iris or the limbus, iris curvature, and the presence of scar tissue can affect the surgeon’s ability to manipulate the iris hooks, Dr. Goldberg said.

The new forceps makes it easier to securely position the hooks. He also noted that the end of the forceps is curved so that it fits easily over the lid.

“I hope colleagues find that it makes iris hook placement simpler, especially for those who don’t use them often, but high-volume surgeons should also find them beneficial,” Dr. Goldberg said.

Lawrence Goldberg, MD

E. rhinoeye@yahoo.com

Dr. Goldberg designed the Iris Hook Forceps, which is available from Rhein Medical.