Precision and safety of the pulsed electron avalanche knife in vitreoretinal surgery.
BACKGROUND
We have developed a new surgical instrument, called the pulsed electron avalanche knife (PEAK; Carl Zeiss Meditec, Jena, Germany), for precise, "cold," and tractionless dissection of tissue in liquid media.


OBJECTIVE
To evaluate the 3-dimensional damage zone induced by the PEAK compared with 2 other standard intraocular surgical instruments, diathermy and retinal scissors.


METHODS
Damage zone and minimum safe distance were measured in vitro on chick chorioallantoic membrane and in vivo on rabbit retina with the use of propidium iodide staining.


RESULTS
The PEAK produced a paracentral zone of cellular structure disruption surrounding a crater and a peripheral zone of structurally intact but abnormally permeable cells. The instrument induced a damage radius that varied from 55 to 300 micro m for the range of voltages and pulses typically used during surgery. For comparison, damage radius for microsurgical scissors was 50 micro m, and for diathermy, 400 to 850 micro m. The PEAK also damaged tissue up to 1.4 mm away by the creation of water flow that formed at the tip of convex probes during collapse of a cavitation bubble. Concave probes, which prevent formation of the water jet, eliminated this effect.


CONCLUSIONS
The PEAK operated well within accept-able safety limits and may greatly facilitate both posterior segment surgeries (eg, membrane dissection and sheathotomy) and anterior segment procedures (eg, capsulotomy, nonpenetrating trabeculectomy, and iridectomy).
Miller
Jason M
JM
Department of Ophthalmology, School of Medicine and W. W. Hansen Experimental Physics Laboratory, Stanford University, Calif 94305, USA.
Palanker
Daniel V
DV
Vankov
Alexander
A
Marmor
Michael F
MF
Blumenkranz
Mark S
MS
D000482:Allantois / Q000601:surgery; D000818:Animals; D002642:Chick Embryo; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D011817:Rabbits; D012160:Retina / Q000473:pathology / Q000601:surgery*; D012449:Safety; D014822:Vitreous Body / Q000473:pathology / Q000601:surgery*