Premium Phaco Keratomes
$3,912.00 – $4,212.00
Gimbel SuperStealth | Gimbel UltraStealth
The surgical axiom “The Opening Determines The Close” is preserved with these premium diamonds. Due to the entire design and quality of Mastel edges, the common stromal appearance of a herringbone-like scarification of the stromal tunnel into the anterior chamber is virtually gone. This leads to superior wound creation and closure, safety profile, and potentially superior control of the chamber. From our perspective, this is what constitutes minimally invasive wounds to begin with.
We first began calling these the ‘Stealths’ when we were told referring optometrists frequently called the surgeons at the one-day postoperative examinations asking what they had changed because they could not find the incisions! It was also easy to lean this way as the laid back front edge section looks like the wings of a fighter jet. Since then, millions of procedures have been performed with our Stealth diamonds over the past several decades.
|Phaco Keratome|| |
1.7/2.2mm With Sharp Tip, 1.7/2.2mm With Bucci Tip, 2.0/2.5mm With Sharp Tip, 2.0/2.5mm With Bucci Tip, 2.0/3.0mm With Sharp Tip, 2.0/3.0mm With Bucci Tip, 2.3/2.8mm With Sharp Tip, 2.3/2.8mm With Bucci Tip, 2.5/3.0mm With Sharp Tip, 2.5/3.0mm With Bucci Tip, 2.4/3.5mm With Sharp Tip, 2.7/3.2mm With Bucci Tip, 2.7/3.2mm With Sharp Tip, 2.4/3.5mm With Sharp Tip, 2.00mm WIth Bucci Tip, 2.00mm With Sharp Tip, 2.2mm With Bucci Tip, 2.2mm With Sharp Tip, 2.4mm With Bucci Tip, 2.4mm With Sharp Tip, 2.6mm With Bucci Tip, 2.6mm With Sharp Tip, 2.8mm With Bucci Tip, 2.8mm With Sharp Tip
Premium Diamond Phaco Keratomes
The first Mastel ultra-thin (100 micron base) diamonds in surgical ophthalmology were introduced in 1987. Many manufacturers continue where we left off then at the 170-200 micron thickness levels, commonly referred to as Industry Standard (IS) blades. By design, this factor alone makes them twice as invasive when applied in a full-thickness penetrating wound.
We then apply reduced-angle facet angles (cutting edge bevel is termed ‘angle alpha’) and we work at 35° as opposed to 45° seen in most IS blades. In addition, the swept back attack angles (imagine the wings of a fast jet airplane for instance) of the advancing cutting edges are set at 60 degrees (Lance) versus 90 degrees (Spear) of many designs. All in all these provide the ultimate, minimally invasive cutting edge technology in cataract diamonds for phaco in the world today.
Furthermore, we specify much higher-quality single crystal diamond material to achieve the highest level of edge quality (600x Mastel edge vs. 100x IS). We also pioneered in the late 1990’s the application of synthesized diamonds, along with our natural single crystal diamonds. This leads to blades that hold their edges indefinitely in the surgical setting when maintained appropriately. A single misstep will damage any diamond, but poor quality material degrades over time due to simple ‘weathering’ by the autoclave.
Available in all common phaco widths from 1.7/2.2mm through 2.7/3.2mm with a special Williams trapezoid of 2.4/3.5mm. All designs are established to allow the surgeon to determine the length of the corneal tunnel to guide the penetration point and have a half millimeter separation between the front piercing V, which is then followed by the trapezoidal ‘wings’ that can enlarge the wound more or less by how far the blade is pushed into the anterior chamber. This allows flexibility between cases of surgeons using the same instrumentation sets.
In some ways, the UltraStealth is a derivative of the SuperStealth. The ultra-thin, reduced-angle cutting edges and advanced materials preserve edge qualities. It is faceted by our diamond cutters in a similar manner to the trapezoids (we call them micro-trapezoids). A very small ‘trimming edge’ is produced on both lateral sides just after the primary dissecting edges have passed into the corneal tunnel. These help to clean up any uncut tissue that may be moving laterally under the forces in the stroma to ensure a clean dissection along the critical wound margins, which on many designs lead to wound leaks that are difficult to diagnose.
These side edges then transition into what is known as a ‘safety bevel.’ This means the blade cannot cut sideways and produces a parallel-sided wound in the most simple, straightforward approach possible. It is less flexible than a trapezoid but will not inadvertently move sideways and create a larger or different incision than desired. This leads to a more reproducible and ostensibly safer wound construction. At the same time, trapezoids are by far the most popular (but this is completely surgeon preference).
The President Series handle features a double threaded mechanism for robust, simple actuation. The mechanism locks securely to eliminate free play of the stylus. The titanium construction and elimination of springs makes them virtually indestructible in clinical service. The President serves as the platform for phaco keratomes, paracentesis blades, glaucoma blades, groovers and any freehand application. The diamond is extended straight or at an angle for maximum clearance and accessibility.
Our three styles of side edge finishes:
The trapezoidal shape has sharp, slanted side edges that can always be resharpened to the same initial dimensions (when length is adequate). Parallel, sharp sides do not allow for this and lead to signification variations between new blades and rehoned blades. We do not produce parallel sides sharp all the way, but instead use a slight angle depending on the application always capable of being repolished correctly.
These side edges are a form of a trapezoid (angled facet to centerline of the diamond) that is only allowed to be sharp a very short distance, followed by the transition to our classic ‘safety bevel’. All UltraStealth diamonds have this side edge feature in both phaco and paracentesis configurations.
Our original solution to a non-cutting parallel-sided blade to make a simple straight in paracentesis without risk of wound enlargement was to simply polish off the four corners (two on each side surface) at 45° angles to get rid of these hard 90° corners which cause trouble with tissue.
The Danger of Unfinished Lateral Edges
The hard corners of unfinished square (90°) corners are ALWAYS REMOVED AT MASTEL. They are actually cutting edges on their own (albeit very dull ones), and they create wound margin defects if not removed. With a simple spear or lance, the sides of the blades are left rectangular, which means you have these ‘hard corners’ or edges above and below the plane of the dissection that has been advanced into the eye. We have not provided these designs to anyone for over a decade because they are wrong. Most wound leaks from the diamond paracentesis profile IS designs are due primarily to this lack of faceting acumen and should not be offered.
Video by Professor Robert Stegmann
"The Opening Determines the Close"
Histological and ultrastructural study of corneal tunnel incisions using diamond and steel keratomes
“The corneal incisions made with the dissecting, stiletto-like keratomes (Mastel Fine Triamond) were distinct from the other incisions, having a smoother stromal surface and much less disruption of stromal tissue. The dissecting incision using the stiletto-like diamond keratomes was ideal with respect to the degree of disruption of stromal tissue.”
Journal of Cataract and Refractive Surgery, Volume 24, Number 4, April 1998
Jacobi et. al., Giessen University, Munich, Germany, Pages 498-502