To the Editor.
—Many surgeons prefer a bimanual expression of the nucleus with a muscle hook applying pressure near the inferior limbus and a lens loop pressing on the sclera near the superior limbus. Both hands of the surgeon are involved in this maneuver.I herein present an instrument (Figure) by which pressure can be applied either at the inferior or superior limbus or both at the same time, utilizing only one hand of the surgeon. The other hand can be used to hold a serrated forceps for retracting the iris, if needed, and/or for impaling the nucleus and cartwheeling it out of the eye. This instrument gives the surgeon a third hand. I have used it on approximately 50 cataract extractions without complications attributable to the instrument.
McDonald JE. A Lens Nucleus Expressor: `A Third Hand'. Arch Ophthalmol. 1986;104(5):638. doi:10.1001/archopht.1986.01050170028005