So now, one of the things that you can do with the Mastel diamond, with regard to creating the deep flap, is you can set it to 100 or 200 micrometers and use the guarded blade to keep you from going too deep.

Before we get to that. What I’m doing here is, with the superficial flap, I just want to keep that from drying out. So I place some viscoelastic on it and will then use the .06 to just place it underneath my bridle suture. And I like this particular type of bridle suture, which takes two bites through the cornea and comes out on either side of the anticipated superficial incision, so that I can do exactly this: I can just tuck the superficial flap underneath the bridle suture and get it out of my way.

Back to the deep flap. We’re now getting ready for the deep flap, high magnification. I actually prefer just to keep the blade fully extended and freehand it. But again, you have to be very, very careful here because, as I said, there is no real tactile feedback, and this blade is so incredibly sharp that if you put any pressure on this, you really could go right into the eye. So, it’s probably a reasonable thing to use the footplate and guard the incision to 100 to 200 micrometers, for most surgeons.

For me, I don’t like to have the footplate there while I’m making this initial outline of the deep flap. Again, here you can see, I’m just using the diamond blade itself to freehand a little edge of the flap so that I can get some tissue held by the .06 and have some room between the .06 instrument and my diamond blade, since I don’t want to take the risk of dulling this very delicate and very expensive diamond blade.

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