Needle Holders and Forceps

7 Needle Holders and Forceps

7.1 Needle Holders

Needle holders for ophthalmic surgery are specially designed for use with small needles, and come in many different sizes and designs. They have either straight or curved tips, or jaws, and may or may not have a locking mechanism ( Fig. 7.1). They are designed to securely hold the needle for passage, using jaws that are appropriately sized for the given needle. Ophthalmic needle holders are generally designed to work with either hand.

An appropriate match between jaw size and needle size is important, not only to hold the needle with the proper and necessary force required, but also to maximize visualization of the ophthalmic tissues while passing the needle. Using a needle holder with jaws that are too small can result in poor control of the needle tip and torqueing of the needle body during a pass through fibrous tissue. On the other hand, using a needle holder with jaws that are too big can reduce the effective length of the needle available for penetrating the tissue, as well as potentially obstructing the view of the tissue being penetrated.

The inside surface of the needle holder’s jaws may be smooth or ridged ( Fig. 7.2). Ridged jaws may improve the grip on larger needles, providing increased stability. This is especially important when dealing with relatively dense tissues offering significant resistance. Ridged jaws are generally not necessary for passing the small spatulated needles typically used for conjunctiva, cornea, sclera, and extraocular muscle.

7.2 Forceps

Forceps are used in suturing for two main purposes: holding tissue and tying knots. As with needle holders, they are available in many different sizes and designs ( Fig. 7.3). A major differentiating feature is whether or not the tips of the forceps have teeth ( Fig. 7.4). Forceps with teeth (either opposed or interlocking) are used to obtain a firm hold on soft tissue while a suture needle is passed through. The size and design of the teeth varies, allowing the surgeon to select the best one based on the tissue characteristics on which it is to be used. In general, larger teeth are needed for the lid and orbit, while very fine teeth are used for cornea, conjunctiva, and sclera. An exception to the use of toothed forceps on tissue occurs in the setting of trabeculectomy surgery, when the utmost care is needed in handling the conjunctiva to avoid making perforations that might leak. In that situation, it is preferable to select forceps with smooth or slightly textured tips, rather than ones with teeth.