Pulsed electron avalanche knife: new technology for cataract surgery

Background: The pulsed electron avalanche knife (PEAK-fc) is a new
pulsed electrosurgical device that allows for precise, ``cold'' and
traction-free tissue dissection.Aim: To evaluate the surgical
applicability, safety and potential complications of PEAK-fc in
complicated cataract surgery.Methods: The study included five
children with congenital cataracts, two patients with advanced
senile cataracts, six adults with mature cataracts, three of them
with posterior iris synechia, three patients with post-traumatic
cataracts with zonulolysis, one patient with intumescent traumatic
cataract and three patients with massive anterior capsule
opacification. Anterior and posterior capsulotomies, iris
synechiolysis, dissection of anterior capsule opacification and
fibrotic scar tissue were performed. PEAK-fc was set at voltages of
500--700 V, pulse duration of 0.1 m and repetition rate of 40--100
Hz.Results: Anterior and posterior capsulotomies were successfully
and safely performed in all eyes. The edges of capsulotomies
appeared sharp, showing only limited collateral damage. PEAK-fc
worked best by just gently touching the capsule, thereby avoiding
tractional forces or pressure on the lens capsule. Posterior iris
synechiae could be released and anterior capsule opacification was
dissected without complications.Conclusions: PEAK-fc is a very
helpful cutting device for complicated cases of cataract surgery,
especially for mature and congenital cataracts, traumatic
zonulolysis or anterior segment complications after intraocular
inflammation.