title: [Can the cutting performance of trephines still be improved?].
abstract: OBJECTIVE
  Today, for the preparation of donor and recipient cornea during keratoplasty either single-use or reusable metal trephines are commonly used although excimer and femtosecond laser systems are available. Due to the surgical techniques as well as the configuration of metal trephine's cutting edge irregular corneal surfaces may be induced. These will result in a postoperative astigmatism. Contemporary manufacturing processes do allow for the production of minimal cutting edge diameters (400 nm -- 1 microm), however, this is related with a reduced mechanical stability of such delicate cutting edges. It has been observed that the cutting edge of metal blades is immediately bent with the first exposure to tissue. As a result, the cutting forces are increasing and the wound configuration is negatively effected. Due to the complex geometry of trephine cutting edges, no diamond trephines are currently available. We are investigating the cutting performance of conventional trephines that were modified using nanotechnology.
  
  
  METHODS
  Different metal trephines were characterised using a scanning electron microscope (SEM). The diameter of the cutting edge was measured. Pig cornea were studied histologically after trepanation. Selected trephines were ion-forged in a modified PVD (physical vapour deposition) reactor using highly accelerated ions which are concentrated by magnetic fields at low temperature. The consecutive processing steps were controlled by SEM analysis of the cutting edge diameters. Randomly chosen areas of treated trephines were analysed. After processing the trephines, pig cornea were cut and analysed by histological and SEM examination. Additionally, the relevant mechanical cutting parameters of untreated as well as treated trephines were measured when penetrating into a PU (polyurethane) foil.
  
  
  RESULTS
  Preliminary microscopic analysis already reveals differences in the quality of the cutting edges. The nanotechnological modification of the cutting edges does not result in larger diameters. Compared with the initial cutting edges, the optical analysis of the modified trephine cutting edges reveals subjectively smoother surfaces. The force measurements prove a reduction of cutting forces for the treated trephines compared to the untreated ones. The SEM analysis show for the cornea treated with the modified trephines a subjectively smoother surface. Histology reveals that the surfaces of the treated cornea do not exhibit a smooth and unidirectional structure. This divergence became larger when untreated trephines were used. The mechanical characterisation of the treated trephines resulted in harder and longer-lasting surfaces.
  
  
  CONCLUSIONS
  The newly developed ion-forging of trephines in combination with nanostructured carbon coatings yield complex cutting edges of higher stability with diamond-like properties. This study shows that the performance of laser trepanation cannot be reached; however, the use of nanotechnology can further improve manual trephine techniques.
authors.affiliation: Universitäts-Augenklinik, Ulm. Christian.Lingenfelder@gmx.de
authors.forename: C
authors.initials: C
authors.lastname: Lingenfelder
authors.forename: S
authors.initials: S
authors.lastname: Kupferschmid
authors.forename: U
authors.initials: U
authors.lastname: Grabowy
authors.forename: L
authors.initials: L
authors.lastname: Kleinen
authors.forename: C W
authors.initials: CW
authors.lastname: Spraul
mesh_terms: D000818:Animals; D003315:Cornea / Q000473:pathology* / Q000601:surgery*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D036103:Nanotechnology / Q000295:instrumentation* / Q000379:methods*; D013508:Ophthalmologic Surgical Procedures / Q000295:instrumentation*; D013499:Surface Properties; D013525:Surgical Instruments; D013552:Swine; D014207:Trephining / Q000295:instrumentation*