I founded the chain of Nethradhama Superspecialty Eye Hospitals in Bangalore, India, where my team and I perform about 10,000 cataract surgeries each year. We use the ZEISS Integrated Cataract Workflow in four of our operating rooms (Figure 1), which improves efficiency in and out of the OR. Patient workup and surgery with the ZEISS Cataract Workflow are based on the following key concepts: assess, educate, plan, treat, and check. Figure 2 illustrates the steps in my process.
Figure 1. Dr. Ganesh’s surgical cockpit contains the QUATERA 700, the CALLISTO, and the ARTEVO 800 (ZEISS).
Figure 2. Dr. Ganesh’s use of the ZEISS integrated Cataract Workflow, from biometry through the completion of surgery.
I begin each patient’s workup by taking ocular measurements with the IOLMaster 700 swept-source OCT (ZEISS), which is extremely precise, with an SS-OCT for measuring axial length and telecentric keratometry. With the touch of a button, I export the data from the IOLMaster 700 to ZEISS’ FORUM ophthalmology software (in the United States, it would be the ZEISS VERACITY Surgery Planner software). This connects to the ZEISS EQ Workplace software, which I use to plan the surgery, including selecting the IOL and the IOL formula I will use.
Next, I transfer these data to the CALLISTO eye (ZEISS) in the OR; it will use the data to create overlays in the eyepiece. The CALLISTO eye’s screen shows me the day’s list of surgeries, from which I select the data for the next patient to be treated, including the IOL I’ve selected and the axis of alignment if it’s a toric IOL. The CALLISTO offers a markerless alignment system for toric IOLs, Z Align, that projects digital axis markers onto the surgical field for precise placement of the IOL. The system also provides guidance for creating capsulorhexes and LRIs.
The QUATERA 700 Phaco Machine
The new ZEISS phaco device, the QUATERA 700, connects to its ARTEVO 800 digital microscope, which has an integrated 3D heads-up display. The details of each case are displayed on the screen of the QUATERA 700, which is very convenient, and my OR technician can watch the procedure on the phaco screen to anticipate the next step.
I am very familiar with the QUATERA 700 phaco system, because I was involved in developing it. One of its main features is its QUATTRO pump, a patented system of four pumps—two for irrigation and two for aspiration (Figure 3). Unlike peristaltic or venturi phaco systems, these 4 syringe-like chambers continuously exchange infusion and aspiration in a synchronized and reciprocal manner. Meanwhile, an irrigation sensor measures the fluid volume and detects any incisional leaks, compensating accordingly to sustain the preset IOP. This system, the QUATTRO pump plus the irrigation sensor, ensures an extremely stable chamber. Surgeons may use the QUATERA 700 phaco system in either vacuum mode or flow mode, to mimic a venturi pump or a peristaltic pump, although it is neither. This capability enhances the machine’s safety and efficiency without any compromise.
Figure 3. The mechanism of the QUATERA pump. The QUATERA 700 is designed with four pumps, two for irrigation (blue) and two for aspiration (purple).
To test the performance of the QUATERA 700, I conducted a single-surgeon study (unpublished data) to compare its chamber stability and other parameters against two popular phaco machines. I randomized 90 eyes with dense cataracts and 90 eyes with soft cataracts to receive surgery with one of the three phaco systems. In the eyes with grade 3+ cataracts treated with the QUATERA 700, I noticed the pupils contracting and expanding, an indication of chamber stability. Even with the vacuum set at 700 mmHg (the highest setting), the QUATERA 700 provided excellent tissue grab and followability.
My patients are brought into the OR on trolleys and can be oriented in a way that I don’t have to change my position or the screens. With this setup and the Cataract Workflow in my OR cockpit, my surgeries are comfortable and efficient.
Dr. Ganesh on the CT LUCIA 621P IOL
ZEISS’ new IOL, the CT LUCIA 621P, is a hydrophobic, single-piece, acrylic IOL that features the aspheric ZO optic design. It has a step-vaulted C-loop haptic, designed for maximum contact with the posterior capsule and with the periphery, and a reinforced optic-haptic junction for refractive stability (Figure 1). The CT LUCIA 621P IOL is implanted with a preloaded injector, which is easy to load and simple to use (Figure 2). The surgeon simply instills viscoelastic over the lens, folds the IOL’s wings, and clicks the IOL into place.
Figure 1. The ZEISS CT LUCIA 621P IOL features a unique hydrophobic acrylic optic and step-vaulted C-loop haptics.
Figure 2. The CT LUCIA 621P IOL exits its injector.
Colleagues and I published the results of a study in which we compared the CT LUCIA 611P IOL with the TECNIS-1 ZCB00.1 Although the outcomes were similar, the TECNIS IOL took significantly longer to unfold in the eye (35 seconds)—almost 3 times that of the CT LUCIA (12.93 seconds). Due to these outcomes with the 611P model, and for its unique aspheric optic design, the CT LUCIA 621P is the preferred monofocal IOL in my practice for routine and difficult cases. The preloaded injector enhances the efficacy, and I get excellent visual outcomes postoperatively.
1. Brar S, Ganesh S, Sute SS, Chidre S. Comparison of clinical results, contrast sensitivity and optical quality following the implantation of CT LUCIA 611P and TECNIS-1ZCB00 monofocal IOLs – 12 month outcomes. Open J OPhthalmol. 2022:16.
