Experience of application of diamond knives in ophthalmic surgery by Dr. Pablo Luis Daponte
Eye surgery is an accumulation of small, well-conducted steps. In order to advance in this kind of surgery, we need to train ourselves for many years, managing to dominate our instruments, to have confidence and safety so that these steps allow us to go onto the next ones.
Since the year 1995, I have been using the 1.00 mm width diamond knives of the company Rumex to conduct my cataract surgeries, cornea transplants and trabeculectomy. 90% of my incisions are sclerocorneal as I think that different works published on endophthalmitis and corneal incisions versus scleral ones produce a rate of 0.05% of endophthalmitis for scleral incisions and 0.29% for corneal ones.
Initially, I was using the Universal Straight Side Port Diamond Knife with 1.00 mm trifaced blade of Rumex (6-10/6-053). However, currently, I am very comfortable with the ones with trapezoid self-diving blades like 6-10/052 or 6-10/6-070, which have an excellent end with an edge and this allows me to make the incision with safety and confidence to have it valvulated. The cost of surgery has decreased remarkably as the instruments can last years with the proper care.
To enlarge the sclerocorneal wounds, I use a scalpel of surgical steel according to the size of the wound that I need to make, currently making it as small as 2.0 mm.
The versatality of the scalpel also allows me to use it in trabeculectomy, the procedure of cutting the scleral lid, which needs to be as soft and precise as possible.
With the use of the 1-mm Rumex diamond, we can control the depth and cut carefully to later make the entry into the chamber and conduct trabeculectomy with Punch.
These diamonds also allow me to make and complete the cut in the trepanation of the cornea. I choose to use them due to the edge they have, which does not require any pressure at that moment as any pressure could lead to damage in the adjacent structures, such as the crystalline and the iris.
I also use a diamond scalpel to make my accuate incisions to lower astigmatism.
For those patients that have 1.0 dp to 2.50 dp of astigmatism and cannot pay the cost of toric lens implants, I make relaxing incisions according to the nomogram of Dr Nichamin from Pennsylvania (USA). The preset scalpels offer the possibility of using them at required depth that range from 600 microns (the pre-set LRI knife 6-600S/6-0531 is the one I use) to 500, 350 or with the free mode.
This means that I can use it for other surgeries, such as with marking the scleral lid in trabeculectomy, or using it for valvulated scleral incisions (350 microns).
I use SKY, which provides help for the wound so that the wound does not go deeper. And in the free mode, it can be used as a paracentesis or incision scalpel.
In short, my relationship with Rumex is mainly based on its excellent scalpels that have accompanied me since my first surgeries.
Watch micro incision cuts with Rumex diamond knives video:
