instrument insider
Accutome Black Diamond Knives
Reviewed by Brett W. Katzen, M.D., F.A.C.S.

I've been using the Accutome Black Diamond Knife exclusively since it first became available; it's an integral part of my cataract surgery procedure. The amazing thing is that these diamonds still cut as beautifully as when we first purchased them.

	Accutome's Black Diamond Knives are available in Clear Cornea, Crescent, Trapezoid and Phaco Spear designs.

I have three knives in one location that have been in use for years. Each one is used on five to seven cases a day, 2 or 3 days a week, depending on who is using them. (Several other doctors at the ambulatory surgery center also use my knives.) After hundreds -- perhaps thousands -- of autoclavings, the knives still cut as if they were brand new. This has not been my experience with the other dimensional diamonds I've used, which need to be babied and re-sharpened frequently.

I originally switched to the black diamond for one simple reason: It makes it easier to create consistent, precise, self-sealing corneal incisions that don't require hydration. Specifically:

► The knife always feels extremely sharp. When I create an incision, it feels like I'm cutting into firm jello, not a tough cornea.

► After thousands of eyes, I've never had a single wound leak.

► If I create the incision before paracentesis and viscoelastic, the diamond travels just the right amount through the stroma before entering the eye and creates a nearly square incision.

► Because the diamond is so consistently sharp, I never need to worry about stripping Descemet's membrane.

► Compared with other diamonds (which I still use if I'm ahead of the autoclaves), the black diamond creates a linear corneal entrance wound every time. Other diamonds sometimes create an irregular cut in the epithelium.

► Lastly, the surface of the diamond is matted (i.e., non-glare), so you're never blinded by a reflection from the microscope light.

I like the Accutome Black Diamond Knife so much that I take it with me when I operate elsewhere.

Dr. Katzen is assistant clinical professor of ophthalmology at the University of Maryland School of Medicine, has served as the medical director of TLC Laser Eye Centers in Baltimore, and practices at the Katzen Eye Group, also in Baltimore. Dr. Katzen has no financial interest in Accutome or the Black Diamond Knife.