Electro surgical unit

Review
1. Suction machine : Diaphragm Pump, Piston,
Peristaltic Pumps, Rotary Vane Suction
Pump, Centrifugal Suction Pump, Venturi
Suction. Check valves, bacteria filter,
pressure gauge, Suction Pump Specifications.
2. Autoclave: sterilization, gravity-displacement
&The Vacuum Cycle.
 Electro surgical unit

Electro-surgery is a simple, well proven, method of making surgical incisions,

control bleeding and destroying unwanted tissue cells by the use of a high
frequency "electrosurgical current".
1875 – Electric current was passed through wire loop until they were red hot and
heat was transferred to tissue by contact with the red hot wire

The ESU developed by Cushing and Bovie was a spark-gap unit that consisted
of two small metal conducting pieces separated by an air gap. It worked like the
familiar automobile spark plug. When voltage rises enough to jump across the
air gap, the air becomes ionized and functions as a conductor.
1924 – Ground reference generator by Dr. Harvey Cushing and Bovie
1970 – solid state generator
1980 – Argon Electrosurgery
 1. Applications of Electricity in surgical units
Electricity is attraction of two oppositely charged
particles, arbitrarily referred to as positive and negative.
when an electrical connection is made between the two
poles of positive and negative, an electrical current flow
between them. This is an exchange of electrons along the
pathway

Electricity must have two poles in order to flow. In

electrosurgical units, when these two poles are localized
in one instrument or probe, it is referred to as bipolar
unit, sine both poles are contained within the one
instrument.
When one of the poles is an instrument, and the other a
remotely located ground pad (dispersive electrode), it is
referred to as a monopolar or unipolar instrument, since
the instrument is only one of the two poles.

Electrosurgical units utilize AC electricity but at

significantly faster rates of reversal for the polarity. ESU’s
utilize frequencies around 350,000 to 500,000 times per
second, or KiloHertz (KHz). Some go up to 3 or 4 MHz.
this extermely high frequency does not interfere with our
own biological process to any significant degree, so
Faradic effects do not apply.
Biological Effects of Electricity:

The effects of Electrosurgical instruments on tissue is due

to heating in some form or another. Electrical principles are
important to an understanding of how and where this heat
may be created by the way it is delivered to an intended site,
intensified and localized.

Electricity can have different effects on tissue, dependent

primarily on the frequency of the current. The 60 Hz current
produces shocks which causes the muscle contraction, pain
and potentially can stop a heart. These are all termed Faradic
effects and are associated with the frequencies from about
this 60 Hz up to 200-300 KHz. Frequencies higher than this
do not produce these types of biological effects.
 Electrosurgery is based on the transformation of
energy from high frequency electric current into heat,
with the resulting effect of cutting and/or coagulating
tissue at the point of current application. As current
passes through tissue, electrons collide with various tissue
components. During these collisions, a certain amount of
energy is dissipated depending on the nature of the
material traversed, which results in a rise in temperature.
Electrosurgical waveforms may be set to promote two
types of tissue effects, namely coagulation (temperature
rises within cells, which then dehydrate and shrink) or cut
(heating of cellular water occurs so rapidly that cells
burst).
Because nerve and muscle stimulation cease at 100,000 cycles/second (100 kHz),
Electrosurgery can be performed safely at “radio” frequencies above 100 kHz. An
electrosurgical generator takes 60 cycle current and increases the frequency to over
200,000 cycles per second. At this frequency electrosurgical energy can pass through the
patient with minimal neuromuscular stimulation and no risk of electrocution.

Fig: Applications of different current frequencies.

The proportion of cells coagulated to those cut can be
varied, resulting in a “blended” or “mixed” effect. The
rise in temperature is governed by Joule’s law:
Q = I2× R × t
where Q is the heat generated by a current of constant
intensity (I) flowing through a conductor of electrical
resistance (R), for a time (t). Tissue electrical resistance
mostly depends on the degree of vascularization and
water content. For example, bone and fat present a
higher electrical resistance than skin and muscles.
When electrosurgery is applied, progressive tissue
desiccation increases tissue resistance, which reduces
current intensity.
The effect of Joule's Law
2 . Electrosurgical unit: Converts standard electrical frequencies from the wall
outlet, which is 50 to 60 Hz, to much higher frequencies, 200,000 to 3,000,000
Hz

High-power, high- Coupling

Power supply Electrodes
frequency generator Circuit

Modulator

Control Circuit
 The basic electrosurgical unit is shown in the fig
above. The high frequency power needed to produce the
spark comes from a high power high frequency
generator. The power to operate the generator comes
from a power supply, the output of which may be in
some cases be modulated to produce a waveform more
appropriate for particular actions. The modulator circuit
controls the output of the generator. The high frequency
power from the generator is ultimately controlled by the
surgeon through a controlled circuit based on required
application, which determines when power is applied to
the electrodes to carry out a particular action.
 Power supply
A power supply unit (or PSU) converts mains AC to low-
voltage regulated DC power for the internal components of
different devices. There are two types of power supply Switched-
mode power supply and linear power supply.
Switched mode power supply.
 High-power, high-frequency generator

Spark Gap Generator

• Vacuum Tubes
• Less safety for handling

Solid State Generator

• Transistor Based Amplifier
• Oscillator Circuit
• Modified waveform- Blend Waveform
• High safety
The coupling circuit controls the energy transfer from
the high frequency generator to the electrodes for various
jobs.

The electric waveforms generated by the

electrosurgical unit differ for its different modes of
action.

Many different designs for electrosurgical units have

been evolved over the years. Modern units generate their
RF waveforms by means of a solid –state electronic
circuits
BLOCK DIAGRAM OF A TYPICAL ELECTROSURGICAL UNIT

Power Output
RF Oscillator Modulator Electrodes
Amplifier Circuit

Function Control
Generator Circuit
Power Supply

Hand Switch
Mode
or
Selector
Foot Switch
RF oscillator: provides the basic high frequency signal, Which is
amplified and modulated to produce the coagulation, cutting, and
blended waveforms.
A function generator: produces the modulation waveforms
according to the mode selected by the operator.
The RF power is turned ON and OFF by means of a
control circuit connected either to a hand switch on the
active electrode or to a foot switch that can be operated
by the surgeon.

An output circuit couples the power generator to the

active and dispersive electrodes .

The entire unit derives its power from a power-supply

circuit that is driven by power lines.
 principle of Surgical Diathermy/electro surgery
Electrosurgery is the application of a high-frequency electric current to
biological tissue as a means to cut, coagulate, desiccate, or fulgurate tissue.
An ESU is an AC source that operated at a radio frequency (RF) in the
range between 300 kHz and 3 MHz

It depends on the heating effect of a high frequency electrical current

which flows through the sharp edge of a wire loop or band loop or a point
of a needle into the tissue

Principle of surgical
diathermy machine
An AC current of any frequency is forced away from the wire's center, toward its outer
surface. This is because the acceleration of an electric charge in an alternating current
produces waves of electromagnetic radiation that cancel the propagation of electricity
toward the center of materials with high conductivity. This phenomenon is called skin
effect.
Since the current tends to flow in the periphery of conductors, the effective cross-section
of the conductor is reduced. This increases the effective AC resistance of the conductor
and results higher energy loss due to ohmic heating.
very high frequencies ( above 20khz), the current will show tendency to flow the skin
surface . It will not show the tendency to flow deep.
The High frequency , the nerves muscles will not contract, instead they sit still and
quiver. This doesn't fire nerves, so the pain and muscle contractions,
Since its flowing on small area of surface the heat energy will produce high than normal
current flow.
It used for:

Cutting
Coagulation
Fulguration
Desiccation

Cutting

Electrosurgical cutting divides tissue with electric sparks that focus

intense heat at the surgical site. By sparking to tissue, the surgeon produces
maximum current concentration. To create this spark the surgeon should hold
the electrode slightly away from the tissue. This will produce the greatest
amount of heat over a very short period of time, which results in vaporization
of tissue. In the cutting it delivers 400 W in 500 Ω load at 2000 V
 Coagulation is performed using waveforms with lower average power,
generating heat insufficient for explosive vaporization, but producing a thermal
coagulum instead. The coagulation process is accompanied by a grayish-white
discoloration of the tissue at the edge of the electrode. coagulation uses 150 W.
Electrosurgical fulguration (sparking with the coagulation waveform)
coagulates and chars the tissue over a wide area. Because the duty cycle (on
time) is only about 6%, less heat is produced. The result is the creation of a
coagulum rather than cellular vaporization. In order to overcome the high
impedance of air, the coagulation waveform has significantly higher voltage
than the cutting current. Use of high voltage coagulation current has
implications during minimally invasive surgery..
Electrosurgical desiccation occurs when the electrode is in direct contact
with the tissue. Desiccation is achieved most efficiently with the “cutting”
current. By touching the tissue with the electrode, the current concentration
is reduced. Less heat is generated and no cutting action occurs. The cells
dry out and form a coagulum rather than vaporize and explode.
homeostasis: the use of continuous radio-frequency for cutting and a
burst wave radio-frequency for coagulation is called haemostatic mode
Fig: Relationship of instrument settings to voltage and current interruption.
Electro-Surgery Techniques:

The electric current can flow only in the electric circuit is closed. In terms of
current flow, there are basically two types of electro-surgical techniques

a. Mono-polar technique
b. Bi-Polar technique

Mono-Polar technique: Mono-polar is the most commonly used electrosurgical

modality. This is due to its versatility and clinical effectiveness. In mono-polar
electrosurgery, the active electrode is in the surgical site. The patient return
electrode is somewhere else on the patient’s body. The current passes through the
patient as it completes the circuit from the active electrode to the patient return
electrode.
6. Electrodes used with surgical Diathermy:
Active Electrode resistance:
 Dispersive Electrode(patient Return electrode)

• It is also called as ‘Indifferent Electrode’ or ‘Patient Return

Electrode’
• The function of the patient return electrode is to remove
current from the patient safely.
• A return electrode burn occurs when the heat produced, over
time, is not safely dissipated by the size or conductivity of the
patient return electrode.
Patient return electrode can be Lead (Metal) plate or Disposable
Type Electrode.
In both case Area should be larger than active electrode about
more than 100cm²
 Disposable patient electrode
• Double contact: the patients
body will form a complete circuit
Since the two sides are not connected
With each other.
• Single contact: the electrode is continuous.
Patient return electrode monitoring REM:
REM™ contact quality monitoring was developed to protect patients from
burns due to inadequate contact of the return electrode. Pad site burns are
caused by decreased contact area at the return electrode site
The system is designed to deactivate the generator before an injury can occur,
if it detects a dangerously high level of impedance at the patient/pad
interface.
Bi-Polar technique: In this technique, both the active electrode and return
electrode functions are performed at the site of surgery. The two tines of the
forceps perform the active and return electrode functions. Only the tissue
grasped is included in the electrical circuit. Because the return function is
performed by one tine of the forceps, no patient return electrode is needed.
 Advantage of bipolar electrode
• It is much safer than Monopolar
• RF current flows only through well defined area,
while in Monopolar current flows back through large
section of patient body
• Risk of patient touch is low
• Less Interference for other instruments
• No ‘patient plate’ or ‘Return electrode’ is required
Electrocautery Vs electro surgery
Electrocautery uses to direct current (electrons flowing in one direction)
whereas electro surgery uses alternating current.
During Electrocautery, current does not enter the patient’s body. Only the
heated wire comes in contact with tissue. In electro surgery, the patient is
included in the circuit and current enters the patient’s body.
A high amount of current is passed through the electrode and burning or
coagulate the tissue.
Electrode for Electrocautery is Scalpel / Wire
Electrocautery is used in surgery to burn unwanted or harmful tissue. Also
used to stop hemorrhage.
9. Safety Aspects in electro-surgical units:
The risks associated with electro-surgery fall into four main categories burns,
electrical interferences with the heart muscles, danger of explosions caused by
sparks and electrical interferences with other medical equipment.

Burns: caused by excess current density at a rate other than that at which it is
meant to be present. The burn usually occurs at the dispersive electrode because
of failure to achieve adequate contact.
High frequency current hazard : Another series hazard
associated with the use of surgical instrument is the
possibility electrocution of the patient from faulty mains
operated equipment, when one side of an electrical circuit
is connected to earth. In order to provide protection against
mains current electrocution, a capacitor is generally
earthed included between the indifferent lead and earth.

Explosion hazards: sparks with ether, alcohol, explosive

anesthetic gas,…. If flammable gases are used, it is
important that the electro-surgical unit be located outside
the zone in which the anaesthetic is used. In addition, the
foot switches of the electro-surgical unit should always be
explosion proof.
some diathermy machines are fitted with automatic anti-
explosion devices which make the sparks occurring at the
active electrodes innocuous. When the foot-switch is
actuated or the finger-tip switch in the electrode handle is
operated, this device causes a stream of nitrogen to
emanate from the electrode handle to form a protective
cloud around the cutting and coagulating electrode before
the high frequency generator is switched on. Hence the
explosive gas mixtures in the immediate vicinity of the
electrode cannot ignite.
 Electrosurgery uses high levels of continuous or pulsed
radio frequency power. It presents some unique
hazards.
 It generates sparks with the attendant ignition hazard.
 It generates radio frequency interference that could
obstruct monitoring.
 It can cause burns at inadvertent ground return paths if
its return circuit is inadequate. Demodulation
products could contain components that cause
fibrillation or stimulation.
 DC monitoring currents can cause chemical burns.
 Capacitive or inductive coupling may occur.
Active electrodes or other applicators of electrosurgical
devices shall be properly secured, as recommended by the
manufacturer of the device, when not in active use.

 If cautery, Electrosurgery, or electrical equipment

employing an open spark is to be used during an
operation, flammable anesthetics shall not be used.

 Flammable germicides or flammable fat solvents shall not

be applied for the preoperative preparation of the field.

 Proximity of high-frequency leads to other wires, causing

capacitive or inductive coupling, with resultant current in
electrodes attached to the patient
The use of electrosurgical equipment is associated with
special risks. For this reason, HF generators and
accessories are listed under the "Critical equipment
technology" group in the relevant statutory regulations.
Risks to patients, operators and third parties can arise from
a number of possible causes. Relevant literature, accessible
statistics and experience gained by companies show these
to be:

 technical deficiency
 unwanted high frequency burning
 incorrect operation
defective accessories
ignition of flammable fluids and gases
risks from improper combination with other equipment

Special mention is made in this context of the fact that

patient positioning injury (decubitus) is often
erroneously referred to as high frequency burning.
 Electro Surgical unit
Analyzers

QA-ES fluke biomedical

 Product Application/Intended Use
• What types of electrosurgical units do these analyzers test?
– General electrosurgical devices.
• Primary measurements
– Generator output
– RF leakage
• Auxiliary features
– Basic REM/ARM testing

Technical Training 46
 Test Standards
• Hospital biomeds and ISOs
– Manufacturers’ specifications (device performance)
– Clinical expectations of device performance
– IEC 61289-2:1994 (High frequency surgical equipment - Part
2: Maintenance)

• Medical device manufacturers

– ANSI/AAMI HF-18: 2001 - Electrosurgical devices
– IEC 60601-2-2: 1998 (Particular requirements for the safety
of high frequency surgical equipment)

1/10/23 Technical Training 47

 TEST MODES
POWER OUTPUT TEST RF LEAKAGE
REM TEST

Continuous
Single Operation
Operation

Power Distribution
 Monopolar Electrosurgery

current flows from the generator to the active electrode, in the hand of the
 
surgeon, at the surgical site.
• current passes through the patient’s body to a dispersive pad, which is the
ground electrode, and back to the generator.

LARGE RETURN ELEVTRODE size allows the spread the current over a larger area
and prevent tissue damage or significant heat buildup.
 Bipolar Electrosurgery

•  Active output and patient return functions are both

accomplished at the site of surgery.
• Current path is confined to tissue grasped between
forceps.
• no patient return electrode is needed.
 Electrosurgical Systems

Grounded Electrosurgical Systems Isolated Electrosurgical Systems

introduction in the 1920s 1968, electrosurgery was
revolutionized by isolated generator
Grounded Electrosurgical Systems
 Grounded Electrosurgical Systems

• Originally, generators used grounded current from a wall outlet. It was

assumed that, once the current entered the patient’s body, it would return to
ground through the patient return electrode.

• But electricity will always seek the path of least resistance. When there are
many conductive objects touching the patient and leading to ground, the
current will select as its pathway to ground the most conductive object—
which may not be the patient return electrode.

• Current concentration at this point may lead to an alternate site burn.

 Grounded Electrosurgical Systems
• Patients are exposed to risk of alternate
site burns;

(1) current follows the easiest, most

conductive path;
(2) any grounded object, not just the
generator, can complete the circuit;
(3) the surgical environment offers many
alternative routes to ground;
(4) if the resistance of the alternate path is
low enough and the current flowing to
ground in that path is sufficiently
concentrated, an unintended burn may result
at the alternate grounding site.
Isolated Electrosurgical Systems
 Isolated Electrosurgical Systems
• The isolated generator isolates the therapeutic current from ground by
referencing it within the generator circuitry.

• the circuit is completed not by the ground but by the generator.

• Even though grounded objects remain in the operating room,

electrosurgical current from isolated generators will not recognize
grounded objects as pathways to complete the circuit.

• Isolated electrosurgical energy recognizes the patient return electrode as

the preferred pathway back to the generator.

• By removing ground as a reference for the current, the isolated generator

eliminates the hazards inherent in grounded systems, most importantly
current division and alternate site burns.
 Isolated Electrosurgical Systems
• If the circuit to the patient return electrode is broken, an
isolated generator will deactivate the system as current cannot
return to its source.

• with isolated circuits mitigate the hazard of alternate site burns

but do not protect the patient from return electrode burns, such
as the one shown at right.

• The only difference between the “active” electrode and the

patient return electrode is their size and relative conductivity.
The quality of the conductivity and contact area at the
pad/patient interface must be maintained to prevent a return
electrode site injury.
 POWER OUTPUT TEST
Per IEC 601-2-2 the power output cannot be reduced by more than 10W, or 5% of the
minimum power output level.
1) Continuous Operation
These tests check the power output characteristics of the ESU and provide output
current (A), power (W), peak-to-peak voltage (V), and crest factor values.
In the Continuous Operation mode the analyzer continues to take measurements once
the START key is pressed. The test is not completed until the STOP key is pressed. The
acts much like a meter during the test, showing increasing and decreasing values, as
received from the ESU.

Load Resistance Range

Equipment IEC ANSI/AAMI
Monopolar 100 - 1000 50 - 2000
ohms ohms
Bipolar 10 - 500 10 - 1000
ohms ohms
 2. Single Operation Test
 In the Single Operation mode the makes a single measurement
of the ESU output after the set delay time. After the
measurement is taken the test automatically stops
3. Power Distribution Test:
The Power Distribution test allows the user to check the power
output performance of the ESU over a range of load resistances.
The test allows to specify a range of loads, over which test the
ESU output power to see if it is within the specified limits.
4.HF Current Leakage or RF : This test checks to see whether or
not the active and dispersive leakage currents are within
acceptable limits. There are four test setups to accomplish this
testing.
 Grounded HF Equipment: Measurements of the HF
current leakage.

• The ESU is grounded. The test load is 200 ohms and the ESU
must be operating at maximum power. The current leakage
measured directly at the instrument's terminals must not
exceed 100 mA.
 HF Isolated Equipment: Measurements of the HF
current leakage from the active and neutral electrodes.
• The test load is 200 ohm and the ESU must be
operating at maximum power. The current leakage
measured directly at the instrument's terminals must
not exceed 100 mA.
Active electrode test setup in compliance with IEC 601.2.2, sec. 19.101b, fig, 104 and
sec. 19.102. (Adopted by ANSI/AAMI HF18-1993)
 4.REM Alarm

• This test ensures that the ESU will sound an alarm if the resistance between the two
neutral electrodes exceeds specified limit.

• The program directs the analyzer to gradually increase the resistance, starting at 10
Ohm and increasing through all available load settings. At a certain value, the ESU
should sound an alarm.

• Some manufacturer recommends a significant delay time (2000-4000 ms), so the

alarm point can be more easily identified.
Keratometer
• A keratometer, also known as a ophthalmometer, is
a diagnostic instrument for measuring the curvature
of the anterior surface of the cornea, particularly for
assessing the extent and axis of astigmatism.
• Astigmatism: a defect in the eye or in a lens caused
by a deviation from spherical curvature, which results
in distorted images, as light rays are prevented from
meeting at a common focus.
• Keratometry provides a measurement of the anterior
curvature of the central 3 mm corneal diameter,
although this area does vary between instruments.
The measure of curvature is used to determine the
power of the cornea, and in order to calculate this the
refractive index of the cornea is required. This is
assumed by the machine and can differ between
instruments, with the range used being between
1.3315 and 1.3380.
 Principle
• Observation of 1st Purkinge’s Image
• Based on geometry of aspherical convex reflecting surface (cornea)
• Object of known size and distance is reflected off the corneal
surface to determine the size of the reflected image with a
measuring telescope
• Calculates the refracting power on the basis of an assumed index of
refraction
• Calculation of Radius of Curvature
R = 2x h’/h
R : radius of curvature x : distance from object to focal point h’ :
image height h : object height
• Power Calculation
P = (N2 – N1 )/R
• In kerato meters, N2 = 1.3375 (assumed R.I. of
cornea) N1 = 1.000 (air)
• P = 1.3375 – 1.000 = 0.3375
• P =337.5 /R (in meters) , note that given R (in milli-
metres)
• Diopter (D) unit to measure optical power.
• It is equivalent to 1/meter.
 Object: Circular mire with two plus & two minus signs.
 Lamp illuminates the mire by means of a diagonally placed mirror. Light
from the mire strikes the patient’s cornea & produces a diminished image
behind it.
 This image becomes the object for the remainder of optical system.
 Objective lens: Focuses light from the image of the mire (new object)
along the central axis.
 Diaphragm and doubling prisms:
 4 aperture diaphragm is situated near objective lens.
 Beyond the diaphragm are two doubling prisms, one with its base up &
other with its base out.
 Prisms can be moved independently, parallel to the central axis of
instrument.
 Light passing through left aperture of diaphragm is made to
deviate above the central optical axis by a base-up prism.
 Light passing through right aperture is deviated by base –out
prism, placing the second image to the right of the central axis.
 Light passing through upper & lower apertures does not pass
through either prism & an image is produced on the axis.
The Bausch and Lomb Keratometer is a one position keratometer that gives readings in
dioptric form. It differs from the Javal-Schiotz in that object size is fixed, image size is
the manipulable variable. The reflected rays are passed through a Scheiner disc with 4
apertures – As there are two prisms, each aligned perpendicular to the other, the major
and minor axis powers can be measured independently without adjusting the orientation
of the instrument.
 The one-position instrument is said to be quicker to use since
once aligned on one of the corneal principal meridians, both
principal meridians can be measured without further adjustment,
hence the ‘one-position’ name.
 Disadvantages include that the instrument design assumes that
the principal meridians lie at exactly 90° to each other, which is
not always the case, especially when the cornea has been
subjected to contact lens wear.
 Also, since it is a one-position instrument, both the vertical and
horizontal mires are imaged at the same time and in higher
degrees of corneal toricity this can mean the vertical mire is not
in focus at the same focusing position as the horizontal mire.
• The Javal-Schiotz keratometer is a two position instrument which
uses a fixed image and doubling size and adjustable object size to
determine the radius of curvature of the reflective surface.
 It uses two self illuminated mires (the object), one a red square,
the other a green staircase design, which are held on a
circumferential track in order to maintain a fixed distance from
the eye.
 In order to get repeatable, accurate measurements, it is important
that the instrument stays focused. It uses the Scheiner principle,
common in autofocus devices, in which the converging reflected
rays coming towards the eyepiece are viewed through (at least)
two separate symmetrical apertures
• Two position variable mire keratometers include the Javal Schiotz and copies.
Measurements of corneal radii are achieved by the physical movement of the
mires along an arc.
 The main criticism of this instrument is that unlike the variable
doubling keratometer, where measurements are made on a linear scale, radii
that fall at the extreme ends of the arc are non-linear and this can lead to
measurement inaccuracy.
 Although two-position variable doubling instruments do require a second
adjustment of the instrument to find and measure the second principal
meridian, they tend to be more accurate because of a longer working distance.
Perhaps the best instrument is the two-position variable doubling keratometer,
especially if it is of telecentric design. The advantage of telecentricity is that
focusing of the eyepiece of the telescope is not necessary and therefore there
are no inaccuracies due to focusing errors. Unfortunately, these telecentric
instruments can be expensive and are not commonly encountered.
 Errors in keratometry
• Diurnal variations in corneal physiology: The refractive index
of the cornea has been shown to exhibit diurnal fluctuations,
and it has been found that these variations in density are
related to corneal hydration. It is not feasible to measure the
refractive index of every individual cornea and as a result an
average value is assumed.
• Contact lens wearers: A contact lens can result in alterations in
the curvature of a patient's cornea. Patients should be
instructed to cease wearing contact lenses prior to their pre-
operative appointment in order to ensure stability of corneal
parameters
• A keratometer makes a number of assumptions when
obtaining measures of corneal curvature. One
assumption is that the cornea is spherical in nature,
which we know not to be the case. The cornea flattens
towards its periphery, and the rate in which it flattens
differs between individuals.
• Improper calibration: Steel balls of known curvature
are used to calibrate manual keratometers. These
should be used routinely to ensure accurate
measurement of curvature, and hence power
• Failure to focus eyepieces: It is important that in
manual kera tometry the eyepieces are focused
correctly, in accordance with the observer's refractive
error. This ensures accommodation is not stimulated,
which can result in erroneous measurements.
• Inadequate tear film: In some instances it is not
possible to acquire a good image of the mires due
to disruptions of the corneal surface, either due to
corneal scarring or to insufficiencies in the tear
film. 
• Previous refractive surgery: Refractive corneal laser
surgery results in changes in the relationship between
the curvature of the anterior and posterior surfaces of
the cornea. Keratometry measurements on patients
who have had previous corneal refractive surgery
(e.g. LASIK) will be higher than the true value of the
corneal power.
Parts of keratometer
 Quiz 5%
1. What is dispersive electrode?(1.5)
2. What is function of keratometer?(1.5)
3. Why do radio frequency is used in electro
surgery?(2)