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Excerpt
Watzke’s silicone sleeve spreader, 2 which represents a variation of an instrument introduced for tear sac surgery, currently remains in wide use. Using smooth forceps, the two ends of an encircling band are separately introduced from opposite directions through the silicone sleeve stretched by the Watzke’s spreader. This maneuver presents sometime some technical, time-losing difficulties. To facilitate the procedure, several instruments have been subsequently described. 3–5 These devices are often uncomfortable to handle mostly because they are required to be held and firmly squeezed with stress of both the surgeon’s muscles and mind.
We have designed a new silicone sleeve-spreader that may have some advantages over those used previously. The new device has been obtained from standard surgical calipers. The spreading platforms are represented by the calipers’ smooth ends set at a 90° angle to the main arms; the platform blades are 2.3 mm long and 1.5 mm wide, tapering with pointed tips (Figure 1).
The silicone sleeve can be gently inserted and easily stretched by simply turning the central microwheel that opens the calipers’ arms. The surgeon’s hand is therefore less stressed and relatively free to perform the maneuvers required to insert and adjust the silicone band. Finally, turning back the microwheel, the silicone sleeve can be readily removed. Another advantage of this device is that it allows even broader bands (such as no. 41 or no. 42) to be easily accommodated (Figure 2).
To further facilitate the procedure we have also modified the Nugent’s forceps. The jaws are widened and set at 90° from the main arms; this allows for better grasping and easier threading of the band through the sleeve (Figure 3).
We have been using this new spreader for the past 3 years on a large number of surgical procedures. It effectively facilitates threading the two ends of the encircling silicone band through the sleeve, hastening scleral buckling procedures.
This instrument is made by Sir Oftalmica (Como, Italy) and available from Romani Intermedica (Rome, Italy).
