instrument insider
ClearCut Sideport (Alcon Surgical)

Most cataract surgeons don't give much thought to the sideport incision, even though it's an integral part of cataract surgery and crucial to surgical efficiency. In reality, it can be difficult to create a self-sealing, reproducible sideport incision in certain patients when using a temporal approach, depending on the anatomy of the orbit. A deeply set eye, a prominent brow or a narrow palpebral fissure can create a significant obstruction.

Traditional, disposable supersharp steel blades are straight, making it necessary to perform a two-step maneuver to create an appropriate corneal tract. In fact, if the eye is very deeply set, a straight blade will probably create a poor incision.

In my experience, the new ClearCut Sideport blade from Alcon is one of the most significant developments of the past year. It consists of an angled, modified MVR (microvitreoretinal) blade. The design and sharpness of the blade make it possible to create a reproducible, square-shaped, self-sealing, corneal sideport incision in a single pass through the cornea -- even when the patient has very deep set eyes or prominent brows. And because the blade is so sharp, little or no counterpressure is necessary at the opposing limbus. (The anterior surface also has a matte finish to prevent reflections.)

While this device may seem very simple, it's had a major impact on the efficiency of my cataract surgery.

Samuel Masket, M.D., in addition to maintaining an active practice, is clinical professor of ophthalmology at the Jules Stein Eye Institute, UCLA School of Medicine, and is heavily involved in clinical research. He's a former member of the Board of Trustees of the American Academy of Ophthalmology and former chairman of the Cataract Special Interest Committee of the American Society of Cataract and Refractive Surgery.

Alfonso Corneal Transplant Knife (RUMEX International)

Recently, Dr. John Michaelos introduced me to the RUMEX International Alfonso corneal transplant knife -- a diamond blade designed with a sharp cutting anterior edge, a lip to slide beneath Descemet's membrane, and a dull backside to let you pass over the iris without damaging intraocular structures. Using this knife minimizes the likelihood of iris trauma from the posterior blade of intraocular scissors, as well as the possibility of damaging the anterior lens capsule when dealing with a narrow anterior chamber.

Because of this margin of safety, when the anterior chamber does narrow, you can make the incision even if the iris is touching the backside of the blade. (Of course, you should avoid this if possible.)

When using the Alfonso blade, it takes about 10 seconds to remove the diseased corneal tissue. I trephine to 90% of the corneal thickness and make an entry site into the anterior chamber using a standard sharp-tipped diamond blade. Next, I inject Healon into the anterior chamber to stabilize the anterior segment. Then I grasp the recipient tissue with 0.12 forceps adjacent to the entry site and insert the Alfonso blade into the recipient's interface beneath Descemet's membrane.

The knife is sufficiently sharp that I can maintain diamond sectility on Descemet's membrane and the residual stroma by simple tension using the forceps. The blade can be advanced using forward pressure alone, without any sawing motion. This results in a smoother recipient rim for subsequent coaptation of the donor.

J. James Rowsey, M.D., is in private practice at Saint Luke's Cataract and Laser Institute in Tarpon Springs, Fla. He has no financial interest in the Alfonso blade or RUMEX International.