Pulsed electron avalanche knife in vitreoretinal surgery.
OBJECTIVE
To evaluate the advantages, disadvantages, safety, and surgical applicability of the pulsed electron avalanche knife (PEAK-fc), a new electrosurgical knife for "cold" and tractionless cutting, in vitreoretinal surgery. PEAK-fc is equipped with an integrated fiberoptic that makes bimanual procedures in intraocular surgery possible.


METHODS
A prospective consecutive trial of 18 eyes in 18 patients who underwent vitreoretinal surgery for proliferative diabetic retinopathy, proliferative vitreoretinopathy, subretinal macular hemorrhage, or macular pucker was performed. The following specific maneuvers were performed with PEAK-fc: transection of epiretinal membranes, retinotomies, retinal vessel coagulation, and posterior membranectomy.


RESULTS
Detached and attached retina could be dissected successfully in eight cases. Intraoperatively, incision edges were sharply demarcated, showing no visible collateral damage. Deeper layers than the neurosensory retina were not affected. With the bimanual approach, epiretinal avascular and vascular membranes could be removed in 10 cases. Hemorrhages occurring during transection of vascularized membranes could be stopped immediately using the coagulation mode of PEAK-fc. Posterior capsule fibrosis was successfully excised in one patient. No complications were observed.


CONCLUSIONS
PEAK-fc offers precise and tractionless tissue cutting during ocular surgery. Using different waveform parameters, the same device performs cold cutting and/or "hot" coagulation, thus improving the precision, safety, and ergonomics of vitreoretinal surgery.
Priglinger
Siegfried G
SG
Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.
Haritoglou
Christos
C
Mueller
Arthur
A
Grueterich
Martin
M
Strauss
Rupert W
RW
Alge
Claudia S
CS
Gandorfer
Arnd
A
Palanker
Daniel
D
Kampik
Anselm
A
D000368:Aged; D003930:Diabetic Retinopathy / Q000601:surgery*; D004598:Electrosurgery / Q000295:instrumentation; D019773:Epiretinal Membrane / Q000601:surgery*; D004869:Equipment Safety; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation*; D011446:Prospective Studies; D012163:Retinal Detachment / Q000601:surgery*; D012166:Retinal Hemorrhage / Q000601:surgery*; D016896:Treatment Outcome; D018630:Vitreoretinopathy, Proliferative / Q000601:surgery*