Surgical Instruments have designs on sight

June 15, 2005

Regardless of ophthalmic specialty, both physicians and instrument makers must have an understanding of the market and patient needs.

Keeping up to date with the latest surgical instrument trends and technology is important not only for ophthalmologists, but for the ophthalmic manufacturers who develop and provide the necessary surgical tools. Regardless of ophthalmic specialty, both physicians and instrument makers must have an understanding of the market and patient needs. In this overview, Ophthalmology Times highlights some of the many innovations and designs in surgical instrumentation available to ophthalmologists.

When it comes to cataract surgery, bimanual phacoemulsification has been making inroads recently-influencing instrument manufacturers to design a host of new devices.

Will it become standard procedure, or will advances in coaxial technology keep that process at the forefront?

"There was an initial burst of interest in the bimanual irrigating choppers, but the interest in those has settled down," Bee said. "I think the first burst of surgeons were the innovators and early adopters. Now we're seeing that surgeons are trying to decide why they should go to the trouble to buy new instrumentation if they still have to open the eye to 2.5 or 3 mm to get a lens in.

"The conventional wisdom is that as soon as the market comes out with a lens that will go through a 1.4-mm incision that's FDA-approved, then this bimanual technique is going to be more and more popular," he continued. "But until that happens, there's a segment out there that's sticking with conventional phaco."

Bimanual phaco instruments and techniques are "barbaric" at this early phase, but in a few years microincision cataract surgery will be demonstrably safer and better and become a major trend, said Doug Mastel, chief executive officer of Mastel Precision, Rapid City, SD.

Here to stay? Others wonder whether bimanual phaco will be a passing fad.

"Bimanual has been the big buzzword for more than 2 years, but it's not going to be defined the way it was in the past. It's going to go through a new definition because Alcon Laboratories and other companies have come up with new technology where you don't need to be bimanual," said Ravi Nallakrishnan, president of ASICO, Westmont, IL. "You can go with the old coaxial technology and be under 2 mm."

Alcon is developing what it calls microcoaxial technology to be used on the Infiniti Vision System, according to Mike Lee, international brand manager, disposables and viscoelastics, Alcon Laboratories Inc., Fort Worth, TX.

"This will allow phacoemulsification [to be performed] in two ways: one through a 2.2-mm incision, which we're calling the ultra-sleeve, and also through a sub-2-mm incision, which we're calling the nano-sleeve," Lee said.

"This technology is going to allow us to implant a full 6-mm-optic IOL through the same incision that you used for phacoemulsification. The anticipation is when this hits the market, probably this fall, bimanual technology will go away," he continued. There will be no need to buy specialized instruments, and surgeons can begin using the technique with virtually no learning curve, he added.

Regardless of the specifics of the incision and lens sizes or debates over the preferred technique for phacoemulsification, it appears that smaller instruments are here to stay.

"We're definitely seeing a lot of interest in microincision cataract surgery instruments," said Sue Yeisley, president, Pelion Surgical Solutions, Boulder, CO.

Greg Toso, director of marketing, branded product, Surgical Specialties Corp., Reading, PA, has seen growing interest in blades that let surgeons make more accurate paracentesis incisions. The company has also developed a series of knives for sub-2-mm microincision cataract surgery, ranging from 0.6 to 2 mm, that can be used with 19- and 20-gauge bimanual phacoemulsification.