Fig. 1
Lieberman speculum
The Barraquer wire vspeculum is commonly used in SICS as there is no bar to restrict the instruments used. It is cheaper and easily available in most places. The only disadvantage of the wire speculum is that the palpebral fissure height cannot be altered (Fig. 2).
Fig. 2
Barraquer speculum
2.
Calipers (Fig. 3):
Fig. 3
Calipers
The caliper is made up of stainless steel with a length of 8.5 cm with measurements in 0.5 mm increments, is calibrated in millimeters, and has a maximum measurement of 20 mm with scale readings on both sides.
The calipers are used in SICS to measure the distance of the incision groove from the limbus.
Used for measurements during surgery:
Cataract incision
Squint surgery
Trabeculectomy flap
Intravitreal injections
Retinal surgery ports
3.
Artery clamp:
The artery clamp is used to hold drapes and to hold or fix sutures.
The most commonly used artery clamp is the straight artery clamp with fine serrations at its tip (Fig. 4).
Fig. 4
Straight Artery forceps
The artery clamp in SICS is used to hold the superior rectus suture tightly to the drape, thereby keeping the field of view of the incisional site immobile, and also to give adequate resistance.
The artery clamp is also further useful in holding the drape together with the drain bag.
4.
Silcock’s needle holder:
The needle holder is used in SICS to thread the needle with a suture through the superior rectus and placing a bridle suture.
The needle holder has a lock in place to hold the needle, and the thumb is placed adjacent to this lock for easy disengagement of the needle after passing the bridle suture (Fig. 5).
Fig. 5
Silcock’s needle holder
5.
Superior rectus forceps (Fig. 6):
Fig. 6
Superior rectus forceps
This is a double angulated forceps to facilitate better view, keeping the body of instrument and fingers away from the field.
The forceps is generally used to hold the superior rectus muscle and pass the bridle suture under the muscle. The angulated tip measures 7.7 mm to grasp the superior rectus from the limbus.
The forceps is held with the tip pointing face down toward the conjunctiva, and the superior rectus is fixed through the intact conjunctiva and held with the help of the toothed forceps. Before the bridle suture is passed, moving the muscle from side to side tests the hold of the muscle and makes sure that the globe moves accordingly so that you do not puncture the globe or do not pass over the muscle and bridle only the conjunctiva and Tenon’s capsule.
6.
Barraquer’s blade breaker (Fig. 7):
Fig. 7
Barraquer’s Blade breaker
The blade breaker allows the surgeons to fashion a fresh, sharp knife for each case. It has a spring lock.
Blade holders have straight jaws that are used to break the tip of a blade by closing the jaws together and breaking the tip manually. The jaw tip is locked using a clasp, and this now can be used for incision.
The thinner and longer the desired fragment, the closer the blade to the cutting edge. The opposing jaws are convex and concave for better grip.
The broken tip should be examined to determine the quality of the blade point.
As pointed by Troutman, the ideal razor blade should have high carbon content.
Used for making incisions in cataract/sac surgeries and chalazion curettage, trimming suture knots, and removing suture.
7.
Crescent knife (Fig. 8):
Fig. 8
Crescent Knife
The crescent knife is used for lamellar dissection and tunnel construction.
This is an angulated steel blade firmly attached to a knife handle or to a plastic handle that provides firm grip and clear field of view while making a scleral incision. It has a rounded tip, which is blunt, and has sharp edges on the sides, which provide smooth tunnel formation [4]. Using this angled crescent knife, the second part of the tri-faceted tunnel is constructed.
There are various types of crescent tips available based on their bevel characteristics:
Bevel up
Bevel down
Straight
Angled bevel up tip only
8.
Side port:(Fig. 9):
Fig. 9
Side port
The side port is made using a Super blade 150.
Used to make side port entry at about 1.5–2 mm from limbus or at limbus.
This is a straight triangular-shaped knife with one edge of the base sharp and the tip is pointed. This can be placed in a blade holder or comes with a disposable plastic handle. This tip is angulated and provides better control while constructing a side port entry.
Helps to form anterior chamber and facilitate second instrument introduction.
9.
Keratome (Fig. 10):
Fig. 10
Keratome
The keratome used to enter the anterior chamber after the crescent has been used to form the tunnel.
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