Getting Started with ZEISS Premium Refractive IOLs - Carl Zeiss ...

Getting Started with ZEISS
Premium Refractive IOLs
Your guide to a successful implantation of
AT LISA ® , AT LISA ® toric and AT TORBI ®

Dear Surgeon,
You have chosen a ZEISS premium refractive IOL as the best
possible option for your presbyopic cataract and regular
cataract patients to attain the optimal post-surgical visual
outcome. We would like to thank you for your trust.
The reliability and safety of our multifocal AT LISA ® product
line has been con firmed in numerous studies. Very good
functional outcomes are apparent in uncorrected near, distance
and intermediate visual acuity. The monofocal AT TORBI ® is the
first bitoric MICS IOL worldwide. With excellent clinical results,
AT TORBI ® is the choice for astigmatic patients who do not
mind wearing glasses or who are not good candidates for toric
multifocal IOL implantation.
This brochure is intended to give you the necessary informa tion
on pre- to post-operative management you need to successfully
get started with the family of ZEISS premium refractive IOLs for
micro incision or regular cataract surgery.
To learn more about appropriate patient selection for a
ZEISS premium refractive IOL implantation, please refer to the
product insert.
Your Carl Zeiss Meditec Team
2

Pre-operative management
As soon as you and your patient have made the decision for
a ZEISS premium refractive IOL, the following pre-operative
measure ments are recommended:
• Optic biometry using the IOLMaster: The goal is emmetropia.
The latest A-Constants can be downloaded at the ULIB web site.
• Keratography of the corneal surface: For an astigmatism up to
1.0 D an implan tation of the AT LISA ® is appropriate. With an
astigmatism of 1.0 D or greater, AT LISA ® toric or AT TORBI ® is
the per fect choice.
• Pupillometry is optional for the AT LISA ® and AT LISA ® toric as
they are pupil-independent due to their diffractive optic design.
3

Z CALC for a fast,
easy and reliable calculation
of the ZEISS toric IOLs
ZEISS premium refractive toric IOLs can be calculated
easily online with the Z CALC toric IOL calculator.
Access Z CALC at
www.iolmaster-online.zeiss.com
4

Key points when using
Z CALC for calculation and ordering:
• Z CALC is optimized for use with the IOLMaster.
Obtain the latest keratometer refractive index from your
IOLMaster printout.
• You can enter axial length, K-readings & ACD data for one
or both eyes on the Lens Calculation screen. The color coded
yellow and red fi elds indicate an entry is outside the `normal‘
range. If the box turns red Z CALC won’t calculate; if the box
turns yellow please verify the patient data.
• Z CALC provides the ability to vary the sphere and cylinder
powers when the IOL refraction appears, to review and adjust
the associated residual refraction.
• With Z CALC, it is possible to select the correct toric
IOL model for one or both eyes before you complete the fi nal
calculation.
• After the IOL selection process, you can print a copy of the
axis alignment transparency (STACY) for surgery. For ordering,
you can print a copy of the lens calculation / order request
and fax or email the signed order request page to your
local Carl Zeiss Meditec business partner.
For detailed information on calculating and ordering
ZEISS toric IOLs, please see the Z CALC Quick Guide.
5

Pre-operative marking
An appropriate marking of the eye for the implantation of
ZEISS toric IOLs is important for the success of the surgery. The
pre-operative reference marking is applied before anaesthesia
while the patient is sitting upright with both eyes open.
The instruments necessary for marking are:
• A corneal marker
• A slit lamp with a grading ring
• Reference points of the eye
Optimal incision size
Ideally, the incision size for a ZEISS toric IOL implantation is less
than 2.0 mm (C-MICS, B-MICS, laser phaco), to avoid inducing
additional astigmatism and to optimize the predictability of the
outcome.
6

Intra-operative IOL alignment
The exact alignment of a ZEISS toric IOL is crucial for a
good post-operative outcome. In order to obtain a correct
position, align the orientation marks of the IOL (flat curvature)
with the steeper meridian of the cornea. The gross alignment
should be done during the implantation of the toric IOL.
8

After the IOL implantation, the viscoelastic should be removed
carefully and completely from both the anterior and the posterior
side of the IOL to avoid rotation beyond the intended fi nal axis.
Even a small amount of residual viscoelastic can cause the lens to
rotate and shift leading to refractive errors.
Rotate the lens after viscoelastic removal. The axis of alignment
should precisely match the calculated target.
For maximum precision you have three options for
ZEISS toric IOL alignment. You can use either the screen
transparency available to print directly from Z CALC or the
reusable STACY transparency provided by Carl Zeiss Meditec.
Z ALIGN, part of CALLISTO eye ® , is a user-friendly touchscreen
system for video documentation and toric IOL alignment
assistance. Z ALIGN is an innovative video-supported tool
that provides greater convenience, reliability and speed for
intra operative toric IOL alignment.
9

Post-operative management
Post-operative checks should be performed one day,
one week and four weeks after surgery. Since this is the
habituation period of the patients with multifocal IOLs,
you should encourage them every time they show up for
post-operative control.
Post-operative check-up
Multifocal IOLs
• Obtain a subjective refraction for distance and near
(it is not recommended to use an autorefractor when
a multifocal IOL has been implanted)
• Perform a keratography
Detlev R. H. Breyer, MD, Germany, recommends to ask your
patients on their last visit whether they would happily
recommend surgery for the implantation of the AT LISA ®
to their best friend. From the vast majority of your patients,
says Dr. Breyer, you will hear a happy: “Yes!”
ZEISS Toric IOLs
• Check the rotational stability of the IOL
Next steps
The second eye should be operated on within a few weeks,
ideally three weeks after surgery of the first eye.
Do not prescribe progressive lenses.
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If you have further
questions ...
... ask your sales representative or your local
Carl Zeiss Meditec offi ce for:
• Wet lab sessions
• Seminars and training courses
• DVD with clinical experiences from well-known
international surgeons
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Acknowledgment
We would like to thank Detlev R. H. Breyer, MD,
GB
Germany, for the valu able support he gave for
the compilation of this brochure.
05/10
Not for sale in the U.S. I/D01147
Carl Zeiss Meditec SAS
La Rochelle / France
Phone: +33 (0) 5 46 44 85 50
czmlr.contact@meditec.zeiss.com
www.meditec.zeiss.com/iol
*Acri.Tec GmbH
A Carl Zeiss Meditec Company
Hennigsdorf / Germany
Phone: +49 (0) 3302-202 6000
EN_70_010_014I CZ-AW-VIII/2009 ATo
IOLMaster ® , AT TORBI ® , AT LISA ® , and CALLISTO eye ® are registered trademarks of Carl Zeiss Meditec.
The contents of the brochure may differ from the current status of approval of
the product in your country. Please contact our regional representative for more
information. Subject to change in design and scope of delivery and as a result
of ongoing technical development.
© 2010 by Carl Zeiss Meditec SAS. All copyrights reserved.