with the ZEISS MICS Platform - Carl Zeiss de México SA de CV

EUROTIMES 

Supplement November 2011 

17 September 2011 

XXIX Congress of the ESCRS 

Vienna 

Take your Practice to a New Level 

with the ZEISS MICS Platform 

Supported by an unrestricted grant from 

ESCRS

1 

Take your Practice to a New Level with the ZEISS MICS Platform 

Introduction 

Name 

Microincision cataract surgery (MICS) is a 

significant advance for improving outcomes 

in cataract surgery. Intraoperatively, the 

technique affords improved control, 

increasing safety and making MICS 

particularly useful in challenging cases. 

Postoperatively, patients achieve faster and better visual recovery 

thanks to the smaller, astigmatically neutral incision. 

However, operating through a smaller incision can place 

increased demands on the phacoemulsification platform, and 

maintaining the benefits of a microincision and providing patients 

with excellent vision depends on the availability of high-quality 

IOLs that can be delivered through an unenlarged incision. 

In a symposium held during the XXIX Congress of the ESCRS, 

leading cataract surgeons discussed how these challenges are 

successfully addressed by the ZEISS MICS Platform. 

BLUEMIXS 180 Injector for Preloaded MICS IOLs – 

New Perspectives for Today’s Modern Cataract Surgery 

Paul Mullaney 

Use of the preloaded CT ASPHINA ® 409MP IOL that comes 

with the single-use BLUEMIXS ® 180 injector (Carl Zeiss) 

enhances the safety and ease of MICS techniques and 

is providing excellent outcomes in a growing series of 

patients, according to Paul Mullaney MD. 

The CT ASPHINA 409MP is a single-piece, monofocal, aspheric 

(aberration neutral) hydrophilic acrylic (25 per cent water content) 

lens with a hydrophobic surface available in dioptric powers 

ranging from 0.0 to +32.0 D. Preloaded in the BLUEMIXS 180 

injector, it can be delivered through a 1.8mm microincision. 

Dr Mullaney said he first implanted the preloaded lens in 

October, 2010, and through September, 2011, he has used it in 

more than 1500 cases. Overall, taking into account his experience, 

feedback from the OR staff, and patient outcomes, his impressions 

are very favourable. 

“I was initially skeptical about the purported advantages of MICS, 

which I thought was chasing the Holy Grail for a smaller incision, and 

I also questioned the benefits of a preloaded IOL. Now I appreciate 

both are advances for surgeons and patients,” said Dr Mullaney, 

consultant ophthalmologist, Sligo General Hospital, Sligo, Ireland. 

“The microincision affords increased anterior chamber stability 

intraoperatively, and use of the preloaded CT ASPHINA 409MP 

IOL maintains the benefits of the microincision for minimising 

surgically induced astigmatism (SIA) and increasing patient comfort 

postoperatively. Together they are a winning combination for 

achieving satisfied patients.” 

Dr Mullaney said both he and his staff appreciate the 

convenience of the preloaded technology that increases surgical 

efficiency and avoids any potential for loading errors by the scrub 

nurse, while also reducing contamination risk. 

“The preloaded system makes the task of IOL handling much 

easier for our presbyopic nurses and leaves me assured that the 

lens will deliver properly every time, without damaged or distorted 

haptics,” Dr Mullaney noted. 

He added that using the BLUEMIXS 180 injector, the IOL is 

delivered with controlled and linear viscoinjection, and with the 

single-piece design of the CT ASPHINA 409MP, there is less risk of 

causing posterior capsule damage by the trailing or leading haptics 

that can occur when implanting a three-piece lens. 

“The ease of use and safety benefits also makes the preloaded 

CT ASPHINA 409MP an excellent platform for training residents,” 

Dr Mullaney said. 

Reviewing his technique for lens delivery using the BLUEMIXS 

180 injector, Dr Mullaney said he operates through a standard 

incision constructed with a three-step technique to create a square 

architecture. When ready to implant the lens, he places the injector 

bevel down on the posterior lip of the wound and advances it 

forward using a repetitive, left-to-right twisting motion of the 

injector. This manoeuvre allows the injector tip to track its way 

into the incision. Advancement is stopped when he feels a slight 

amount of resistance, which indicates the injector tip has reached 

the level of Descemet’s membrane. 

CT ASPHINA 409MP

Name 

“Improved patient comfort has 

been one of the big benefits 

I’ve noticed after MICS” 

Dr Mullaney described two techniques for delivering the IOL. 

His preferred method is to use the injector to rotate the eye up to 

a vertical position. This causes the cornea to flip over the superior 

aspect of the injector and allows the tip to be moved 2-3mm 

further into the anterior chamber so that the lens can be released 

into the capsular bag where it nicely unfolds. 

Alternatively, the lens can be injected once the tip of the 

introducer has reached Descemet’s membrane, in which case the 

lens will be released diagonally in the anterior chamber with the 

base of the lens in the inferior portion of the capsular bag. It can 

then be tapped gently into position in the capsular bag using a 

bimanual I&A tip. 

“When first advancing the injector, I stop at Descemet’s 

membrane because attempting to move it further risks stromal 

dissection. I prefer the first technique for delivering the lens because 

it enables in-the-bag placement in a single manoeuvre, which has 

been achievable in about 80 per cent of cases,” Dr Mullaney said. 

“If the lens is introduced without the injector entering the anterior 

chamber, because of the downward angulation of the eye, complete 

placement in the bag is unlikely with a single manoeuvre.” 

With the MICS procedure, patients enjoy good postoperative 

comfort, and they have been very happy with the quality of their 

vision. There have been no postoperative complications in this 

relatively large series, and although follow-up is short, the lenses 

are very stable, and there is no evidence for increased posterior 

capsule opacification (PCO). 

“Improved patient comfort has been one of the big benefits 

I’ve noticed after MICS. Complaints of a foreign body sensation, 

presumably due to the lip effect of the incision, are now rare, but 

were common among patients operated by using incisions larger 

than 2.8mm,” Dr Mullaney said. 

“The potential for more PCO is one worry I have with MICS, 

and I did experience problems with significant fibrin accumulation 

in some young and diabetic patients implanted with a MICS lens 

from another manufacturer. So far, no eyes implanted with the 

CT ASPHINA 409MP have undergone YAG laser capsulotomy. Of 

course surgical technique, including attention to meticulous cortical 

cleanup and polishing of the anterior capsule, is also critical for 

maintaining capsule clarity.” 

In addition to the CT ASPHINA 409MP, other aspheric, singlepiece 

ZEISS MICS IOLs are available preloaded with the BLUEMIXS 

180 injector. They include the monofocal CT ASPHINA 509MP, the 

monofocal toric AT TORBI 709MP, the multifocal AT LISA 809MP, 

and the multifocal toric AT LISA toric 909MP. 

Dr Mullaney has no financial interest in Carl Zeiss or its products 

mentioned here. 

Paul Mullaney – paul.mullaney@hse.ie 

17 September 2011 XXIX Congress of the ESCRS 

CT ASPHINA 409MP IOL – Technical Data 

BLUEMIXS 180 injector in OR 

2

3 


MICS and Toric IOLs – targeting optimum outcomes 

Name Michael Goggin 

MICS with implantation of a ZEISS MICS toric IOL 

delivers excellent refractive results that can be 

attributed to the accuracy of the manufacturer’s 

advanced calculation algorithm (Z CALC ® ), the 

procedure’s astigmatic neutrality, and the IOL’s rotational stability, 

according to Michael Goggin MD. 

“Cataract surgeons can address pre-existing astigmatism by 

placing the main incision in the steep meridian. However, this is 

an imprecise method of astigmatic reduction and not necessary 

in clear cornea MICS with a toric IOL for which keratometric SIA 

is essentially nil,” said Dr Goggin, The Queen Elizabeth Hospital, 

University of Adelaide, South Australian Institute of Ophthalmology, 

Woodville South, South Australia. 

“Surgeons can correct larger amounts of astigmatism with 

greater accuracy using a toric IOL with an astigmatically neutral 

incision. The refractive outcome still will depend on proper power 

selection and intraocular stability of the IOL, but these factors are 

optimised using ZEISS MICS toric IOL technology.” 

Dr Goggin explained that a MICS technique is preferred when 

implanting toric IOLs because the smaller incision size with a 

clear corneal technique allows astigmatic neutrality 1 . However, 

maintaining this benefit of the MICS incision necessitates use of an 

IOL that can be delivered through the smaller incision. 

“To my knowledge, only Carl Zeiss markets toric IOLs (AT LISA ® 

toric and AT TORBI ® ) that are capable of insertion through an 

unenlarged microincision,” he said. 

As an alternative, cylinder power of the toric IOL can be selected 

to correct for any surgically induced astigmatism (SIA), and toric 

IOL power calculation formulae are designed to correct for SIA. 

However, this method involves predicting postoperative corneal 

astigmatism, which is not exact in every case. 

“Using a MICS technique and MICS toric IOL that leave the 

preoperative astigmatism unaltered is clearly preferable,” he said. 

Achieving precise refractive outcomes with toric IOL implantation 

also depends on the accuracy of the power calculation formula, and 

the ZEISS algorithm is unique in incorporating additional factors that 

improve its performance. In addition to data on keratometry axis 

and corneal astigmatism power, Z CALC is the only manufacturer’s 

toric calculator that includes anterior chamber depth (ACD)/ 

predicted effective lens position and axial length/IOL sphere power to 

determine IOL corneal plane equivalent cylinder power. 

The programme also asks surgeons for the source of axial length 

data (contact or immersion ultrasound or laser interferometry) and 

the refractive index used by the keratometric measurement device. 

AT TORBI 709M 

“...only Carl Zeiss markets toric IOLs 

(AT LISA toric and AT TORBI) that 

are capable of insertion through 

an unenlarged microincision” 

In addition, it allows surgeons to modify sphere and cylinder powers 

according to the targeted residual refraction. With these tools to 

hand, rational and accurate IOL cylinder power choices can be made 

for large and small refractive errors. 

In a published paper, Dr Goggin and colleagues demonstrated the 

potential for error in predicted cylinder power using a simpler toric 

calculator (Alcon AcrySof Toric Calculator). This calculator does not 

take into account the variation in toric IOL corneal equivalent cylinder 

power with ACD and IOL sphere power variations 2 . Comparing 

the manufacturer’s calculated IOL corneal plane power with a 

corrected value allowing for sphere power variation, they showed 

the magnitude of error was small using a toric IOL with sphere and 

cylinder powers in the standard range. However, there appeared 

to be significant error with a low sphere, high cylinder toric IOL. In 

an example based on a toric IOL with +17.0 D sphere and 6 D of 

IOL plane cylinder, the manufacturer’s stated corneal plane cylinder 

power could be underestimated by 1.1 D. 

In the same paper, Dr Goggin and colleagues reported findings 

from calculations of corneal plane effective cylinder power of the 

IOL for 38 eyes implanted with a toric implant (SN60TT, Alcon). The 

results showed how the prediction of the toric effect was improved 

taking into account ACD and sphere power of the IOL. 

These concepts are illustrated by Dr Goggin’s personal results 

implanting ZEISS MICS toric IOLs in 52 consecutive eyes. His 

technique involved coaxial MICS through a 1.8mm temporal clear 

corneal incision that was stretched slightly after IOL insertion. Mean 

(SD) incision width after IOL insertion for the 52 eyes was 1.9mm 

(0.15). Calculations based on pre- and postoperative keratometry 

data showed the incision was astigmatically neutral; mean (SD) SIA 

was 0.5 (0.32) D. “As we’ve reported 3 , keratometric SIA of up to 

0.5 D is just ‘noise’, essentially indistinguishable from test-to-test 

variability of the measurement technique,” Dr Goggin explained. 

Mean (SD) distance logMAR UCVA was 0.13 (0.16), which is 

equivalent to 6/7.5. Among 50 eyes capable of BCVA 6/12 or 

better, mean (SD) distance logMAR BCVA was -0.02 (0.13), which is 

equivalent to 6/6. 

Dr Goggin has no financial interest in Carl Zeiss or its products 


Michael Goggin – michael.goggin@health.sa.gov.au 

References 

1. Kaufmann C, Krishnan A, Landers J, et al. Astigmatic neutrality in biaxial 

microincision cataract surgery. J Cataract Refract Surg 2009;35:1555-62 

2. Goggin M, Moore S, Esterman A. Outcome of toric intraocular lens 

implantation after adjusting for anterior chamber depth and intraocular 

lens sphere equivalent power effects. Arch Ophthalmol 2011; 

129:998-1003 

3. Goggin M, Patel I, Billing K, Esterman A. Variation in surgically induced 

astigmatism estimation due to test-to-test variations in keratometry. 

J Cataract Refract Surg 2010;36:1792-3

MICS & VISTHESIA for a High Level 

of Patients’ Satisfaction 

Paul O’Brien Name 

Use of a pain relief ophthalmic viscoelastic device 

(OVD; VISTHESIA ® , Carl Zeiss) during MICS assures 

intraoperative comfort throughout the procedure and 

therefore optimises patient satisfaction with the surgical 

experience, according to Paul O’Brien MD. 

Noting that he practises in both private and public hospital 

settings, Dr O’Brien said he currently performs about 50 cataract 

procedures per month. About half of those cases are MICS, and he 

uses the CT ASPHINA 409MP with the BLUEMIXS 180 injector in all 

eyes undergoing a MICS procedure. 

“About 95 per cent of my cases are done with topical 

anaesthesia, and I always use VISTHESIA because it maintains 

comfort for my patients and so for me as well,” said Dr O’Brien, 

consultant ophthalmologist, Blackrock Clinic, Royal Victoria Eye & 

Ear Hospital, Dublin, Ireland. 

He added that he considers any patient who is not suitable 

for topical anaesthesia as a candidate for general anaesthesia. 

However, Dr O’Brien said he was confident recommending 

VISTHESIA to surgeons who are considering switching from 

subTenon’s injections to topical anaesthesia. 

“Speaking from experience training residents, VISTHESIA has 

made the transition to MICS with topical anaesthesia relatively easy 

and straightforward,” he commented. 

Each package of VISTHESIA includes two 0.3ml ampoules of 

VISTHESIA topical containing 0.3 per cent sodium hyaluronate 

and two per cent lidocaine plus a 0.8ml syringe of VISTHESIA 

intracameral containing one per cent lidocaine and 1.0 per cent 

or 1.5 per cent sodium hyaluronate. The sodium hyaluronate in 

VISTHESIA topical protects and hydrates the cornea, reducing the 

need for drops during surgery and maintaining corneal clarity, 

and with the ample volume of VISTHESIA intracameral, there is 

generally enough product left over after intracameral instillation for 

use in filling the cartridge of the BLUEMIXS 180 injector. 

“It is very rare that I need a second syringe of viscoelastic to 

finish the case even after using some of the material to fill the IOL 

cartridge,” he said. 

Dr O’Brien noted that he started performing phacoemulsification 

under topical anaesthesia in 2001 and undertook a study 

investigating its performance using amethocaine in 100 consecutive 

patients 1 . The patients received no sedation or intracameral 

anaesthesia, and they were asked to rate their pain during sequential 

stages of the procedure using a visual analog scale of zero to 10. 

“...I always use VISTHESIA because 

it maintains comfort for my 

patients and so for me as well” 

OVD: VISTHESIA 

Phacoemulsification was associated with the highest mean pain 

score (1.18) followed by IOL insertion (0.84), and none of the mean 

pain scores for any of the intraoperative stages was significantly 

higher than the mean reported for instillation of the topical 

anaesthetic drops (0.47). 

“Based on these data, after I administer the topical anaesthetic, 

I always tell my patients that any subsequent unpleasant sensation 

is unlikely to be any worse than the little bit of grittiness they 

just experienced. This information reassures and relaxes them,” 

commented Dr O’Brien. 

Discussing his technique for using VISTHESIA in his topical 

anaesthesia cases, Dr O’Brien first cautioned that the outer surface 

of the ampoules of VISTHESIA topical are not sterile, and so the 

product should not be placed on the instrument tray. He begins by 

first placing a single drop of 0.5 per cent proxymethacine into both 

of the patient’s eyes. 

Placing this anesthetic in the unoperated eye helps to prevent 

any discomfort that patients might experience if any povidoneiodine 

used during the prep splashes into the fellow eye,” 

Dr O’Brien explained. In his protocol, Dr O’Brien uses povidoneiodine 

for the scrubbing of the patient’s eye. 

VISTHESIA topical is only instilled on the operated eye at the 

beginning of the surgery. Once the instillation is made, he injects 

VISTHESIA intracameral, noting that he also places some product 

over the clear cornea incision as he believes that may reduce the 

risk of recurrent corneal erosion. 

After cataract removal is completed, he uses a wound-assisted 

IOL insertion technique with the BLUEMIXS 180 injector to deliver 

the CT ASPHINA 409MP preloaded IOL in his MICS cases. 

“I find there is less twisting and turning of the injector using the 

wound-assisted technique, and even though lens insertion can be 

one of the more painful surgical steps, no patients have complained 

about discomfort when I use VISTHESIA,” Dr O’Brien said. 

Note: VISTHESIA is not for sale in UK or Portugal. 

Dr O’Brien has no financial interest in Carl Zeiss or its products 


Paul O’Brien – mrpaulobrien@mac.com 

Reference 


Surgery 

1. O’Brien OD, Fulcher T, Wallace D, Power W. Patient pain during different 

stages of phacoemulsification using topical anesthesia. J Cataract Refract 

Surg 2001;27:880-3 

4

5 


Quality of Life Following Implantation of AT LISA 

vs. Other Multifocal IOLs 

Name Jorge L Alió 

Results from a prospective, randomised, parallel-group (four 

arms) study underscore the importance of looking beyond 

near visual acuity outcomes when assessing the benefits of 

a multifocal IOL, according to Jorge L Alió MD, PhD. 

Global evaluation of the outcomes for the study that compared 

three multifocal and one monofocal IOLs showed that the 

AT LISA ® 809M (Carl Zeiss), a full diffractive, aspheric multifocal 

IOL, offered the best profile overall considering impact on visual 

acuity, functional performance, optical effects and quality of 

life. The study also showed that although patients implanted 

with another multifocal IOL benefited with increased near vision 

function, they failed to achieve improvement in quality of life. 

“Quality of life data are complex and can be difficult to interpret 

because psychology is involved and patient perceptions may be 

influenced by multiple factors. However, I am convinced this type 

of information represents the best way to understand if we are 

helping our cataract surgery patients,” said Dr Alió, professor and 

chairman of ophthalmology, Instituto Oftalmológico de Alicante, 

Universidad Miguel Hernandez, Alicante, Spain. 

“Although we know that implantation of a multifocal IOL 

improves near vision, surgeons must realise this technology can 

also cause photic phenomena, including halos and glare, along 

with contrast sensitivity loss. As demonstrated in our study and 

representing a first-time finding, quality of life after multifocal IOL 

implantation does not always improve when patients gain near vision 

function if that benefit occurs at the cost of poor quality of vision.” 

Dr Alió and colleagues investigated vision-related quality of life 

after cataract surgery using a validated Spanish version of the 

25-item National Eye Institute Visual Function questionnaire (NEI 

VFQ-25). They enrolled 88 patients undergoing bilateral cataract 

surgery, ages 49 to 85 years, who were randomly assigned into 

four equal groups to be implanted with the AT LISA 809M, a 

spherical monofocal IOL (CT 48S, Carl Zeiss), a refractive multifocal 

IOL (ReZoom, Abbott Medical Optics), or the +4 D add, apodized 

hybrid diffractive multifocal IOL (SN6AD3; AcrySof ReSTOR, Alcon). 

Patients received the same IOL in both eyes. 

The quality of life questionnaire along with wavefront 

aberrometry measurement of high order aberrations (HOA) and 

tests of near and far visual acuity, reading speed, and contrast 

sensitivity were performed preoperatively and postoperatively 

at scheduled visits through six months. The statistical analyses 

included correlation testing to understand how visual parameters 

influenced different quality of life items with different IOLs. 

Summarising some of the key findings, Dr Alió noted that 

while correlation analyses showed better near visual acuity and 

reading acuity were strongly associated with improved perceptions 

of quality of vision, wellness and general health, patients 

implanted with the monofocal IOL still benefited with a significant 

improvement in quality of life. Despite their lack of recovery 

of near vision, the monofocal IOL patients achieved significant 

improvements in a variety of tasks, including the ability to find 

items on a crowded shelf, read street signs and store names, and 

navigate down stairs or curbs in dim light or at night. In addition, 

the monofocal IOL was associated with the best contrast sensitivity 

among the four implants and was best for driving vision. 

Results for the multifocal IOLs showed far vision was best with 

the AT LISA and the results were comparable to those achieved in 

the monofocal group. Patients implanted with the diffractive 

AT LISA multifocal IOL and the hybrid apodized ReSTOR multifocal 

IOL showed improved performance of near tasks, such as reading 

newspapers or shaving, and improvement in performance of near 

vision function was better with the two diffractive technologies 

(AT LISA and ReSTOR) than with the refractive, ReZoom IOL. 

Reading speed was best in the AT LISA patients followed by patients 

implanted with the ReSTOR IOL, whose performance was superior 

to the ReZoom IOL group. 

“Correlation analyses for patients implanted with the refractive 

ReZoom multifocal IOL showed reading improved when HOA 

RMS is low, but among the multifocal IOLs, the refractive ReZoom 

induced more HOA than the aspheric ReSTOR and AT LISA. In the 

ReSTOR group, we also found an inverse relationship between 

contrast sensitivity and reading difficulty, and contrast sensitivity 

was better for the AT LISA than with the ReSTOR,” said Dr Alió. 

Driving difficulty was also related to contrast sensitivity, and as 

contrast sensitivity was worse with the ReSTOR IOL than with the 

AT LISA, the apodized hybrid diffractive ReSTOR multifocal IOL was 

also associated with more driving difficulties comparing the two 

diffractive lenses. 

Dr Alió concluded with a global evaluation of the IOLs taking 

into account their impact on visual performance and quality of 

life. In categories of far vision, near vision, reading speed, contrast 

sensitivity function and effects on HOA, the AT LISA performed 

equal to or better than each of the three other IOLs, and it was 

superior to all of the other implants in improving quality of life. 

Using an Olympic medal analogy, Dr Alió concluded the AT LISA 

receives the gold medal. 

Dr Alió has no financial interest in Carl Zeiss or its products 


Jorge Alió – jlalio@vissum.com 

AT LISA 809M

First Experience with the ZEISS VISALIS 500 

Phaco Machine 

Name Ekkehard Fabian 

The VISALIS 500 is a new state-of-the-art modular 

phacoemulsification and vitrectomy system that enables safe 

and efficient surgery, according to Ekkehard Fabian MD. 

“There are benefits for operating through a smaller 

incision, but MICS also places increased demands on the phaco 

machine for maintaining safety and efficiency. The VISALIS 500 

was designed with MICS capabilities in mind, and its innovative 

features provide surgeons with flexibility benefits while also 

assuring control,” said Dr Fabian, private practice, AugenCentrum 

Rosenheim, Germany. 

Dr Fabian was involved in the development of the VISALIS 500 

platform. Two models are available – the VISALIS S500 for cataract 

surgery and the VISALIS V500 for combined cataract and/or 

vitreoretinal surgery. 

Highlighting the features of the VISALIS 500 machines for 

cataract surgery, Dr Fabian mentioned the Surge Security Software 

that constantly analyses the intraocular environment and uses the 

information to adjust pump function to maintain high chamber 

stability. In addition, the VISALIS 500 offers a wide selection of 

ultrasound emission modes including cold phaco, an advanced 

fluidics system with dual pump technology, a dual-linear footpedal 

and an intuitive, user-friendly graphic user interface. 

The dual-linear footpedal is hardware that is familiar to those 

who do retinal surgery or are accustomed to operating with 

Venturi pump-based units. It has benefits of allowing surgeons 

to independently control aspiration and phaco power in order 

to maximise safety and efficiency while also providing ease in 

changing functions.“Using the footpedal, the surgeon can adjust 

the operative technique in a variety of ways to maintain safety, such 

as switching between programs and changing bottle height. By 

reducing dependence on nursing assistance for changing functions, 

this technology also increases OR efficiency,” Dr Fabian said. 

“I begin surgery with a peristaltic 

pump and switch to the venturi 

pump after completing the first 

two quadrants” 

With the VISALIS 500 dual pump system, surgeons can enjoy 

on-the-fly switching between Venturi (vacuum-based) and rise-time 

controlled peristaltic (flow-based) pumps and take advantage of the 

individual performance characteristics of the two modes according to 

their surgical needs while also maximising efficiency and safety. 

Noting that he had a long-standing preference for a peristaltic 

pump, Dr Fabian said that since he began using new venturi-type 

machines, he increasingly integrated the Venturi pump into his 

surgical technique. This happened also with the VISALIS 500 so 

that currently, he uses the Venturi mode for the entire procedure 

in nearly all cases. 

Using an intraoperative video, he demonstrated the 

performance of the VISALIS 500 with the Venturi pump in a MICS 

case. After good hydrodissection and hydrodelineation, the phaco 

tip could be maintained in the centre while the nuclear pieces 

came directly to the tip.“With a Venturi pump, vacuum is created 

instantly by the pump thus providing immediate followability. 

Using a peristaltic pump, vacuum is created on occlusion of the 

phaco tip thus providing better holdability. Today’s dual pump 


machines like the VISALIS 500 have this better followability but do 

not lose the holdability functionality,” he explained. 

“The peristaltic pump offers greater anterior chamber stability. 

However, when using the Venturi pump during fragment removal, 

there is no need to move the tip to chase the fragments, and that 

is not possible when operating with a peristaltic pump unless high 

settings are used,” he said. 

Dr Fabian noted that if he is particularly concerned about 

maintaining anterior chamber stability, such as in an eye with a very 

narrow anterior chamber, he begins surgery using the peristaltic 

pump and switches to the Venturi after completing removal of the 

first two quadrants.“In situations where there is very low volume in 

the anterior chamber, I want to control vacuum, and I prefer to use 

the peristaltic pump for increased stability,” he said. 

Dr Fabian also observed, that pump choice also reflects individual 

surgeon preference, and different surgeons may use a variety of 

different techniques in which they incorporate both pumps into their 

surgical protocol. For example, one surgeon may start the procedure 

using the peristaltic pump for chopping and mobilising quadrants 

and then switch to the Venturi pump for removing the epinucleus 

and OVD. Another surgeon might also start using the peristaltic 

pump for sculpting and chopping, but switch to the Venturi pump 

for segment removal, while a third surgeon might start using 

the Venturi pump for chopping, switch to the peristaltic pump 

for fragment removal, and revert to the Venturi pump to finish 

epinucleus and cortex removal. 

With VISALIS 500, surgeons have the possibility to flexibly define 

their own surgical protocol to optimise the balance between high 

patient safety and surgery efficiency, Dr Fabian said. 

ZEISS surgery solution offers surgeons other innovative products 

for improving workflow efficiency and surgical results, including 

FORUM and CALLISTO eye ® . FORUM is a software product for digital 

integration of clinical data from compatible diagnostic instruments. 

CALLISTO eye offers remote microscope control, integrated HD 

video documentation, patient data display in the OR and a range of 

assistance functions, include Z ALIGN ® , a video-supported tool for 

guiding precise intraoperative axis alignment of toric IOLs. 

Dr Fabian has no financial interest in Carl Zeiss or its products 


Ekkehard Fabian – prof.fabian@augencentrum.de 

6

ESCRS 

EUROTIMES 

Supplement November 2011 

17 September 2011 

XXIX Congress of the ESCRS 

Supported by an unrestricted grant from

with the ZEISS MICS Platform - Carl Zeiss de México SA de CV

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