Device aids intraocular visualization

Key Points

Lexington, KY-A proprietary surgical microscope (OPMI Lumera, Carl Zeiss Meditec) allows dynamic control of the red reflex to provide unsurpassed intraocular visualization and to improve the ease and safety of cataract surgery, said Gary Wortz, MD.

Support for Dr. Wortz's perspective was based on a retrospective study conducted at the Lexington VA Medical Center in collaboration with John Gullett, MD, resident, department of ophthalmology, University of Kentucky, Lexington. The study investigated rates of vitreous loss in patients undergoing cataract surgery before and after the acquisition of the microscope.

The analysis showed a 42% reduction in vitreous loss rate after the change in equipment, from 4.6% during the period when the Leica microscope was used to 2.7% after the switch to the Carl Zeiss Meditec microscope. Dr. Wortz postulated that improved visualization offered by the newly acquired microscope to both the primary surgeon and the supervising attending surgeon accounts for the difference.

"My theory is that the stereo coaxial illumination feature of the microscope can allow a younger, less experienced surgeon to achieve results similar to a much more seasoned surgeon," he said. "Furthermore, because the quality of the image seen through the assistant's microscope and displayed on the monitor is better using the microscope, the ability of the attending surgeon to teach and communicate with the resident is improved, even to the point where it may be possible in some cases to avert trouble before it occurs.

"This study includes a fairly large sample size and benefits from the ability to retrieve accurate data using the VA system of computerized medical records," Dr. Wortz added. "[Although] it was a retrospective study based on consecutive chart analysis, the data are fairly compelling in substantiating that the microscope is a true asset to the cataract surgeon and offers an important benefit for reducing the morbidity and costs related to cataract surgery."

Red reflex

Adjustable stereo coaxial illumination is what allows dynamic control of the red reflex and distinguishes the microscope from other microscopes. Using this feature, surgeons can increase the illumination easily to achieve a better red reflex and improved contrast, creating an optimal environment with unimpeded direct visualization and one where guesswork is removed from the equation.

"There are many situations where obtaining a good red reflex is problematic, such as in the patient with small pupils, darkly pigmented eyes, or a dense cataract, and even when a good red reflex is obtained, maintaining it can be an issue if the patient looks off-axis," Dr. Wortz said. "Faced with the latter situation, I would sometimes have to operate with just one hand as I used the other to hold the eye steady manually. Now, operating with the [new microscope] is like having a third hand."

Dr. Wortz added that he also has decreased his use of trypan blue to enable capsulorhexis in eyes with very mature cataracts as a result of the improved red reflex obtained using the microscope.

FYI

Gary Wortz, MD
E-mail: bluegrasseyes@gmail.com

Dr. Wortz received an honorarium for speaking for Carl Zeiss Meditec 2 years ago, but currently has no financial interest in the company. He is in private practice at Bluegrass Eye Surgery, Lebanon, KY.