Hindawi Publishing Corporation Journal of Ophthalmology Volume 2013, Article ID 784172, 4 pages http://dx.doi.org/10.1155/2013/784172 Research Article Intraocular Microsurgical Forceps (20, 23, and 25 gauge) Membrane Peeling Forces Assessment Raul Velez-Montoya, 1 Chirag Patel, 1 Scott C. N. Oliver, 1 Hugo Quiroz-Mercado, 2 Naresh Mandava, 1 and Jeffrey L. Olson 1 1 Department of Ophthalmology, University of Colorado School of Medicine, Rocky Mountain Lions Eye Institute, Aurora, CO 80045, USA 2 Department of Ophthalmology, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA Correspondence should be addressed to Jefrey L. Olson; jefrey.olson@ucdenver.edu Received 8 April 2013; Accepted 10 June 2013 Academic Editor: Michel Eid Farah Copyright © 2013 Raul Velez-Montoya et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. To assess the peeling forces exerted by diferent calibers of microsurgical forceps on an experimental model of epiretinal membrane. Methods. A model of epiretinal membrane was constructed using thin cellulose paper and heptanes-isopropyl alcohol 1% mixture. he model was mounted on a force censoring device. Subsequently, laps were created with three diferent microsurgical forceps of diferent calibers. We recorded the number of attempts, the duration of the event, and the pushing and the pulling forces during the peeling. he results were compared by a one-way ANOVA and a Fisher unprotected least signiicant diference test with an alpha value of 0.05 for statistically signiicance. Results. here was a statistical signiicant diference on the pulling and pushing forces between the 25 gauge (13.79 mN; −13.27 mN) and the 23 (6.63 mN; −5.76 mN) and 20 (5.02 mN; −5.30 mN) gauge, being greater in the irst ( < 0.001). here were no diferences in the duration of all events, meaning that all the forces were measured within the same period of time. Conclusions. he 25 gauge microsurgical forceps exerted the greatest mechanical stress over our simulated epiretinal membrane model and required more attempts to create a surgical suitable lap. he clinical implication of this inding is still to be determined. 1. Introduction he surgical resolution of vitreoretinal diseases involves the micromanipulation of very fragile structures. A successful surgery depends upon the surgeon possessing a particular set of skills that include precise manual dexterity, ine visual- motor coordination, and improvisation capabilities, acquired ater long hours of training [1, 2]. Imprecise movements due to tremor, poor visibility, and fatigue oten may result in tissue damage which can be irreversible and sight-threatening depending on location [3, 4]. Macular surgery is one such scenario in which external factors (patient movements and surgical instruments), along with the surgeon’s dexterity, may inluence the outcome [5]. Macular hole (MH) repair, epiretinal membrane (ERM), and internal limiting membrane (ILM) peeling are perfect exam- ples where the application of unknown forces to the tissues may lead to hemorrhage, tearing, and potential irreversible visual loss [5–7]. With the introduction of minimally invasive surgical techniques (23 and 25 gauge vitrectomy), macular diseases are addressed surgically more oten and earlier than ever [5]. Along with the change in surgical paradigm, several aspects of retinal instruments have undergone further reinement [8, 9]. Microsurgical forceps (MSF) play a central role on macular surgery, since they allow ine surgical delamination, grasping, and manipulation of delicate structures such as ERMs and ILM. Since the ability to achieve surgical objectives during macular surgery is determined in part by the limits of the instruments used, we assessed the magnitude of peeling force that diferent sizes of MSF are able to exert over tissue during ocular surgery. Being aware of these forces and limit their impact on the retina, has the potential to improve