I find the GRIESHABER DSP 25-gauge forceps (Alcon Laboratories, Inc., Fort Worth, TX) to be an indispensible tool in the anterior segment surgeon's armamentarium. They are very useful for stabilizing a subluxated IOL for repositioning.These forceps maintain a firm grip on acrylic, PMMA, and notoriously slippery silicone material, so they are useful for removing silicone IOL or silicone IOL fragments pieces (Figure 1). I use the MAXGrip forceps (Alcon Laboratories, Inc.) for stabilizing the silicone IOLs during lens cutting.

CAPSULORRHEXIS
The MAXGrip forceps and the epiretinal membrane End-Grasping forceps are extremely useful for completing capsulorrhexis in cases where the anterior chamber is particularly shallow (Figure 2).For these cases, the eye should be overpressurized with viscoelastic material.

In some cases where the lens is subluxed, I need to enter at an odd angle,making incision creation a challenge.The forceps can be curved between one finger and thumb to come in at almost a 90° arc over the nose or from an inconveniently positioned location, all while maintaining effective articulation (note: this is an off-label use).

The 25-gauge DSPs are also exceptional for retrieving a capsulorrhexis that is going peripheral in an area where regular forceps are unable to reach, particularly distal to the main incision in a routine cataract case.DSPs can be employed to convert a posterior capsular tear to a capsulorrhexis, or for a case where an intentional posterior capsulorrhexis is created and I want to maintain a pressurized globe. In such a case, once the posterior capsule has been opened, I want to maintain a pressurized globe and I achieve this by entering the paracentesis with the 25-gauge forceps while the anterior chamber is filled with DiscoVisc OVD (Alcon Laboratories, Inc.).The small gauge of these forceps along with the pressurized chamber prevents vitreous prolapse.

CAPSULAR TENSION RINGS
I find that the DSP forceps are also useful for cases where we are placing transcleral sutures for sutured capsular tension ring placement. The forceps are inserted through a scleral wall opening, and the desired suture is removed from the anterior chamber, pulling it from the chamber outside the scleral wall (Figure 4). In this way,we are able to retrieve the suture without having to pass the needle through the scleral wall. Passing the needle through the scleral wall in a capsular tension ring placement can potentially puncture the capsular bag by going either abinterno underneath the iris or abexterno through the scleral wall. Because the DSP forceps are blunt,we can make the opening in the wall, insert the forceps, and retrieve the suture in a safer manner.

ARTIFICIAL IRIS
The MAXGrip forceps in particular are indispensible in the manipulation of the silicone based custom-fixed Artificial Iris (HumanOptics,AG, Erlangen,Germany). The forceps can be manipulated either from the “pupil” margin or the “peripheral iris”margin with a good grip through a small incision either through paracentesis or through single-stab incisions in the scleral wall.

SUMMARY
The GRIESHABER DSP 25-gauge forceps are well made and reliable for difficult cataract procedures. Typically reusable forceps that can grasp as well as the DSPs are only available in larger gauges,which require a somewhat larger wound.

Having some small-gauge DSP forceps on hand in the anterior segment OR makes sense. Most anterior segment surgeons are not going to have access to a wide variety of reusable retinal instrumentation,but most ASCs and hospitals that facilitate retina procedures will have DSPs on hand. If the anterior segment surgeon keeps one box of these in stock, it provides the opportunity for easy access in those difficult cases that can occur.

Michael E.Snyder,MD, specializes in diseases and surgery of the front of the eye. He is on the faculty and Board of Directors at Cincinnati Eye Institute.Dr.Snyder teaches residents locally as a Volunteer Assistant Professor of Ophthalmology at University of Cincinnati.Dr.Snyder reports that he is a consultant to HumanOptics, Alcon Laboratories, Inc.,and Haag Streit USA,and that he is an investigator for Alcon Laboratories, Inc.,HumanOptics, Holos, and I-Therapeutics.He can be reached via e-mail at Msnyder@cincinnatieye.com.