instrument insider
Accutome's LRI Knives
Reviewed by Stewart Van Horn, M.D.

Like many cataract surgeons, I occasionally use limbal relaxing incisions during surgery to minimize a patient's astigmatism. I've used several different knives for this purpose while performing more than 1,000 cataract surgeries each year in my own surgery center and several different hospitals located in central Pennsylvania. In recent years, however, I've been using Accutome's LRI knife almost exclusively.

Accutome's LRI knives are available in three preset depths and two handle lengths.

I use the Accutome LRI knife primarily for two reasons: cost and safety. When I initially spoke to the hospitals about purchasing an LRI knife, we talked about ordering blades costing $2,000; they looked at me as if I were crazy. Then I did a little research and found that the Accutome LRI knife was less expensive; that made the hospitals more willing to purchase it for me. Remarkably, the lower cost has not resulted in lower performance. In my experience, the incisions are just as accurate as those made by any other blade I've tried.

The reason this blade is so safe to use is that each one has a set depth; I don't have to worry about mistakes that could alter the outcome. In this respect it's kind of foolproof.

I use the 600-micron blade, which is usually about the right depth for the peripheral cornea. (According to Accutome, about 90% of surgeons use that depth.) I also use the optional fixation ring, which helps me ensure that my incisions are placed correctly, following the Nichamin nomogram (my personal preference).

The knives themselves are quite durable; I've been using them for a couple of years now and not one has been chipped. Care is simple. Our tech uses BSS to remove loose debris; then we sterilize the knife.

Currently, I use four of the LRI knives. Three of the four hospitals I operate in have purchased one for me, and we have one in our surgery center. Having only a single instrument at each location hasn't been a problem, because I only need the knife once or twice on an average surgery day.

Dr. Van Horn is a general ophthalmologist practicing at the Laurel Eye Clinic in central Pennsylvania.