As usual, the consultation section in the August 2001 issue was quite interesting.1 It discussed cataract surgery in a posttraumatic eye that resulted in a dislocated cataract secondary to zonular damage. I perform a great deal of complicated surgery involving posttraumatic cases and Marfan's syndrome, about 5 cases of the latter each month. In the consultation case, the majority opinion was to stain the capsule and then perform a capsulorhexis. From my experience, I do not think this is the ophthalmologist's best option at the present time.
The U.S. Food and Drug Administration has recently approved a novel device that we call the “plasma blade” but is called the Fugo blade in the U.S. after its inventor, Dr. Richard Fugo. I use this device every day at our eye hospital because it provides a precise, resistance-free incision. It is powered by flashlight-size rechargeable batteries and allows an actual cutting time of more than 1 hour per charge. It cuts sharper than a diamond blade. The secret to its function is that it creates a microscopic plasma cloud on the blunt, hair-thin cutting filament. The plasma cloud can be seen by the human eye.
The Fugo blade has revised my thoughts about managing cases such the one presented. Now, I place a small amount of viscoelastic material in the anterior chamber. Then I trace the Fugo blade tip over the intended path of the incision in the anterior capsule. I can increase the diameter of the capsulotomy by tracing arcs of capsule along the capsulotomy rim or by placing radial Fugo blade incisions in the capsulotomy rim. Each maneuvers takes 4 to 5 seconds to perform. Also, radial Fugo blade incisions in the capsule do not spontaneously tear. You will not disturb the position of the weakened lens because the unit cuts in a resistance-free manner. This resistance-free cutting capability has been discussed (F.H. Roy, MD, “The Frictionless Cutting Tool Is Approved for Capsulotomy, but Potential Uses Abound,” Ocular Surgery News, September 1, 2001, pages 35, 38).
The blade technology is undergoing clinical protocols in many areas such as glaucoma, vitreoretinal, refractive, and plastics. The blade has been used for bloodless tonsillectomy, bloodless resection of throat cancer, and revision of severe facial scars by plastic surgeons. Our hospital staff uses the unit constantly. We even do pediatric cataracts with it.
Daljit Singh MD, DSc
1. Masket S. Consultation section; cataract surgical problem. J Cataract Refract Surg 2001; 27:1152-1160