I want to enter the OR relaxed and make the surgical experience as calm and efficient as possible for myself, my team, and my patients. This means taking all my measurements ahead of time, so I can just perform the surgery and leave. To achieve that, I use the ZEISS Cataract Workflow, because it streamlines my preoperative planning and intraoperative calculations for smooth and easy surgery.
The IOLMaster 700
How do we surgeons obtain reliable preoperative measurements and take them to the OR? It all starts with good data. I feel that the IOLMaster 700 is a key component of surgery. Not only does it obtain preoperative measurements efficiently, but I think it is user-friendly for us and our technicians. The device employs something called telecentric keratometry, which ensures accurate measurements of the eye, no matter the pupil’s size. The IOLMaster 700 also scans the macula to ensure alignment, and its swept-source OCT can help us detect ocular pathology, such as vitreomacular traction, epiretinal membranes, and edema.
Preoperative Planning
After we’ve taken preoperative calculations, we want to choose an IOL for a patient. The ZEISS VERACITY Surgery Planner is software that synthesizes all the diagnostic data—from the IOLMaster, topography, and any other imaging device—and allows us to run calculations with different IOL powers. The VERACITY software can be used on any device, which allows you to plan surgeries from anywhere.
In the Surgical Cockpit
The data from VERACITY then go straight into the CALLISTO eye software in the OR, which transfers the calculations to the ZEISS ARTEVO 800 digital microscope with 3D heads-up display. With the press of a button, the CALLISTO eye automatically takes my preoperative IOLMaster scans and references them with a live scope scan. Thus, I can reference all the blood vessels and mark where 180º is on the eye. Because these measurements are centered on the visual axis (a plus sign indicates the center), I can create the capsulotomy on the visual axis as well. This assistance with centration is especially useful in eyes with small pupils, iris defects, or other irregularities. The CALLISTO eye can maintain these markings even if the patient’s eye moves during surgery. The software also provides alignment marks for implanting toric IOLs and creating limbal relaxing incisions.
Phacoemulsification & Fluidics
For cataract surgery, I use the QUATERA 700 phaco machine. My technicians love its phaco screen, which shows them the live video of the surgery, so they can see what I am doing in real time. During surgery, the CALLISTO eye’s overlay on the ARTEVO 800’s 3D headset shows me the strength of my vacuum and how much fluid I’m using. The QUATERA 700 phaco machine has great vacuum—I’m a huge fan of vacuum-based systems, because fragments come to the tip easily. Although you do not need occlusion to build vacuum, the QUATERA 700 provides independent control of fluidics, which creates very stable chambers. I can leave my phaco tip in the middle of the eye and let those nuclear pieces come to me without using a second instrument. It’s not enough to have fast vacuum during surgery; we want it to be safe at the same time.
Summary
What I like about the ZEISS Cataract Workflow is that it simplifies the steps of preoperative assessment and surgery, and then it allows me to have all the pertinent data at my fingertips in the OR for surgical efficiency and precision. When I think about how accurate we want to be, with IOLs being positioned to a specific degree, doing manual calculations no longer makes sense to me. I want my surgeries to be as accurate as possible. Finally, the ZEISS platforms work beautifully. I have a large screen with amazing depth perception, my staff appreciate the surgical view so that they can proactively anticipate what I need next, and these features keep us on time.
