Bausch + Lomb’s Pinnacle 360 25-gauge scleral fixation forceps were developed to improve the ease and efficiency of surgical maneuvers in the anterior segment and anterior vitreous, such as placing scleral-sutured posterior chamber intraocular lenses.

“Previously available vitreoretinal small-gauge forceps were designed to be long and straight to reach the posterior pole,” says Daniel Adelberg, MD, a vitreoretinal specialist and ophthalmologist at Southwestern Eye Center in Phoenix who developed the prototype for the new forceps with Bausch + Lomb’s team. “The forceps are unique in that they have a short, curved shaft, which allows for maneuvers in the anterior segment and vitreous with more precise hand position and less hand supination and wrist extension.”

The new design reduces the torque and bending of the shaft of longer straight forceps, continues Dr. Adelberg. The forceps also allow for better access around the nose, orbital rim, and speculum.

Maneuvers involving the transscleral fixation of posterior-chamber intraocular lenses (TSSPCIOL) technique, which Dr. Adelberg pioneered, can also be performed with the forceps. The TSSPCIOL technique allows for controlled placement of sutures without long needles into and out of the sclera with forceps. The suture is handed off from one scleral fixation forceps at the sclera to a second scleral fixation forceps introduced at the limbus.

“These maneuvers can be performed with greater safety, precision, control, and efficiency with the scleral fixation forceps,” Dr. Adelberg says. “These combined features can lead to reduced operative times by approximately 5 minutes and improved outcomes.”

PRODUCT ORIGINS

Chuck Hess, vice president and general manager at US Surgical, Bausch + Lomb, says the company was prompted to create the forceps after Dr. Adelberg suggested creating a device to improve the efficiency of intraocular surgical maneuvers.

“Managing patients without capsular support presents diverse clinical presentations with a variety of surgical decision making and challenging surgical maneuvers,” Dr. Adelberg says.

Hess says the scleral fixation forceps fit well within Bausch + Lomb’s development capabilities and complement its line of Pinnacle 360° instrumentation. The Pinnacle 360° portfolio features a multitude of forceps, scissors, and specialty devices for foreign-body extraction and procedures on myopic patients. “The new forceps further diversify this product offering,” he says.

The product’s name points to the main objective of the design, which is to support both ends of the “handshake” technique for passing sutures from forceps positioned in the corneal incision to forceps positioned in a sclerotomy, Hess says. A unique aspect of the device is its ability to maintain cannula compatibility when externalizing the suture through a 25-gauge instrument cannula.

MORE SPECIFICS

The forceps can be considered for any maneuver that requires forceps in the anterior chamber. “The instrument can be especially helpful when angle of entry, surgeon hand positioning, or wound distortion are of concern,” Hess says.

The forceps’ 25-gauge shaft and tips have a brushed finish designed to reduce glare, resulting in excellent visualization. When transitioning to the instrument tip, users will encounter a long, grasping platform that has undergone a patented fine-wire process to create microserrations that promote traction and engage sutures securely, Hess says.

The size and curvature of the distal tip and shaft have been designed so that the forceps will pass through an instrument cannula when a suture is in grasp, Hess says. Rigidity is maintained through the use of a stiffening bushing at the proximal end of the shaft.

The Pinnacle 360°’s actuation handle provides flexibility on grip orientation and ease of compression, Dr. Adelberg says. The forceps feature ergonomic 360-degree actuation.

To improve placement of the forceps through 25-gauge platforms with the extra diameter of the suture, the forceps’ shaft and tips were reduced to 26 gauge, Dr. Adelberg notes. By reducing the size of the microserrated jaw and shaft, surgeons are able to maintain cannula compatibility with a suture in grasp, even though the jaw profile is enlarged. The jaws of the forceps are serrated to improve gripping of sutures.

FINAL THOUGHTS

“I am proud to have partnered with the Bausch + Lomb team to develop this new instrument, which delivers the same features and quality I’ve come to rely on from this line, while filling a significant unmet need in my operating room,” Dr. Adelberg concludes. RP