Fig. 2.15 23-gauge-Tano diamond dusted membrane scraper, which serves as a Òtissue sweeperÓ for ILM or membranes. DORC. 1290.DSS06

Fig. 2.16 With the 25-gauge Spaide CRVO knife, we perform a slight incision of the membrane or the ILM. The scraped edge of the membrane or ILM can then be removed with an Eckardt forceps. DORC. 1293 LO.5

with endodiathermy. ÒNon-activeÓ diathermy is a straightforward endodiathermy probe with a pointed tip. Appropriate use of the endodiathermy probe requires some training. If the settings are too strong or the tip is held too close to the retina, an iatrogenic retinal break can easily be created.

Exodiathermy probe

The exodiathermy is used to diathermize (bloody) episcleral vessels.

2.2.1Instruments for Macular Surgery

Tano diamond dusted membrane scraper

The instrument has a ßexible diamond dusted silicone tip (Fig. 2.15). It is used for the peeling of the internal limiting membrane (ILM) or epiretianl membrane (ERM) by gently stroking the ILM until it tears. The ILM edge can then be removed with the Eckardt forceps.

Neurotomy (CRVO) knife

The neurotomy knife (Fig. 2.16) is a useful tool for manipulation of ERM. It is a good alternative to the Tano diamond dusted membrane scraper. You carefully stroke the membrane or ILM with the neurotomy knife until the membrane tears. The membrane edge can then be removed with the Eckardt forceps. In our opinion, the neurotomy knife is easier to handle than the Tano diamond dusted membrane scraper. The neurotomy knife from DORC is built only in a 25-gauge version, which can also be used together with 23-gauge cannulas.

Fig. 2.17 A 23-gauge membrane pic, which is used for mobilization of membranes. This instrument can mobilize the edge of a membrane. The edge can then be grasped with forceps. Geuder. G-37 503

Fig. 2.18 A 23-gauge Eckardt forceps for precise grasping of an epiretinal membrane and ILM. DORC. 1286.W06

Membrane pic

The membrane pic is angled at the end. It is very useful for the lifting of membrane edges (Fig. 2.17). A lifted membrane (edge) can then be removed with Eckardt forceps.

Eckardt forceps and endgripping forceps

The Eckardt forceps have two jaws and are an instrument frequently used for the manipulation of membranes, removal of ILM or ERM (Fig. 2.18). The endgripping forceps are a more powerful than the Eckardt forceps.

2.2.2Instruments for Peeling for Diabetic Retinopathy and Traction Retinal Detachment with PVR

Serrated (Jaws) forceps

These forceps have the shape of a crocodile jaw and exert more traction and grip than the Eckardt forceps. They are therefore more suitable for the removal of PVR membranes, grasping a dislocated IOL or intraocular foreign body (Fig. 2.19).

Straight or horizontal scissors

The horizontal scissors have two straight blades. They are used for dissecting membranes from the retina, for example, in proliferative diabetic retinopathy or PVR retinal detachment (Fig. 2.20).

Fig. 2.19 23-gauge serrated jaws forceps, which can be used for grasping thicker peripheral membranes. Not suitable for ILM. DORC. 1286.C06

Fig. 2.20 Straight or horizontal scissors. They are useful for cutting membranes in PVR retinal detachment or diabetes. Geuder. G: 36 578 or DORC. 1286.JO6

Fig. 2.21 The knob spatula has a beaded top. Indication: Non-traumatic massage of the retina, blunt manipulation of membranes and haemostasis. A very useful instrument. EyeTechnology: VR-2095

Knob spatula

The knob spatula has a thick knob at its tip. Indication for use is the manipulation of membranes or a retinal massage. A retinal massage is necessary if there are retinal folds (Fig. 2.21).

Retinectomy scissors (vertical scissors)

These 23-gauge retinectomy scissors have two angled blades. They are used to create a retinectomy, for example, in PVR retinal detachment (Fig. 2.22).