CLEANING OF OPHTHALMIC DIAMOND SCALPELS

BACKGROUND: To ensure optimal performance, it is imperative to properl y maintain the condition of ophthalmic diamond scalpels. Refractive su rgeons are often confronted with conflicting cleaning recommendations from manufacturers. The problem encountered is to maximize cleaning wh ile minimizing trauma to the diamond to maintain its longevity. METHOD S: The author describes a flexible graded approach to cleaning and mai ntaining diamond scalpels. The principle of this approach was the deve lopment of four successive levels of cleaning based on an increasing r isk of trauma to the diamond: Level I-irrigation with distilled water, Level II-hydrogen peroxide or enzyme cleaning, Level III-ultrasonic a nd detergent cleaning, and Level IV-mechanical styrofoam block cleanin g. The protocol was performed prospectively on 50 consecutive radial k eratotomy cases, inspecting the blade microscopically after each clean ing step, and determining the level at which cleanliness of the blade was achieved. RESULTS: The effectiveness (clean/dirty) of each cleanin g level was evaluated by the author and an experienced surgical assist ant. The difficulty in accurately measuring the amount of debris and t he force necessary to remove it, limited the judgments made to subject ive observation. Only 2 of 50 blades were cleaned at Level I, while 41 of 48 at Level III, and 7 of 7 at Level IV. CONCLUSIONS: A multi-leve led systematic process for cleaning maintenance appears most effective for maximal performance and longevity of diamond scalpels used for re fractive keratotomy surgery.