Plasma knife provides clean and accurate cut for capsulorhexis

By Ana Hidalgo-Simón MD, PhD

NICE - A new plasma knife which provides a clean and accurate cut for capsulorrhexis no matter how difficult the case was among some of the innovations showcased at this year's XX ESCRS Congress.

Daljit Singh MD presented his clinical experience with the knife in difficult cases in which central curvilinear capsulotomies were required. This device has recently been approved by the FDA for capsulotomies.

The plasma knife is an electro-surgical device consisting of a bent insulated capsulotomy tip with a 100 micron bare filament at its tip. It provides pulsed energy. The tip reaches a temperature of 450ºC but heat is very localised so there is little collateral damage.
With the anterior chamber filled with viscoelastic, the plasma knife tip can be moved along the surface of the anterior capsule to perform the capsulotomy.

The chamber is kept inflated by infusion while the plasma knife performs the capsulotomy and trypan blue is used to ensure the cut is competed.
"You can be sure of a perfect capsulorrhexis with this tool. For some very difficult cases, this knife is the only way you could operate on them.
"Any other method will fail. The difference in the quality and cleanness of the cut between manual and plasma knife incisions is considerable," Dr Singh said.
He reported that the knife was particularly useful in mature cataracts in which the behaviour of the interior capsule can be unpredictable.
It is most useful in anterior capsules with fibrotic bands, dotted thickening or fused capsules.

Dr Singh and his colleagues are looking into other applications for the plasma knife in ophthalmic surgery such as filtration surgery for glaucoma, management of proliferative tissues in vitreoretinal surgery, as well as for oculoplastic surgery and presbyopia surgery.

The portable and relatively inexpensive device costs about E15,000 and may be particularly useful in the developing world. With appropriate training, the plasma knife is safe, simple to use and easy to maintain, he noted.
The plasma knife is also known as the Fugo blade named after its inventor Richard Fugo MD. Dr Fugo also founded Medisurg Research and Management Corporation which markets the device.

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