ZeptoLink offers integrated precision pulse capsulotomy
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The creation of the anterior capsular opening is one of the most critical steps of cataract surgery.
This opening, either capsulotomy or capsulorrhexis, needs to be strong to withstand nucleus and cortex removal, and it needs to be precisely created so that a full 360° overlap of the IOL optic is achieved. Surgeons can perform a capsulorrhexis with a cystotome or forceps, but there is a steep learning curve to achieve the skills to make the capsular opening precise and well centered. More than a decade ago, we began to use femtosecond lasers to make the anterior capsulotomy with good success but also with a high cost and the inconvenience of doing a laser procedure before actually starting the cataract surgery.
Source: Uday Devgan, MD
The Zepto and ZeptoLink devices
The original Zepto device (Centricity Vision) uses a brief (4 ms) pulse of energy to instantly create a precise 5.1 mm anterior capsulotomy under the direction of the surgeon. No matter the case, whether a small eye or a large one, the capsular opening will always be precisely 5.1 mm in diameter. In prior years, we used a separate console to create a vacuum to secure the Zepto device to the anterior lens capsule before delivering the precision pulse energy. With the new ZeptoLink device, the vacuum is provided by the phaco machine while the surgeon has full control via the standard phaco foot pedal. There are handpieces that can make a 5.1 mm or 5.4 mm diameter capsular opening, depending on the desires of the surgeon (Figure 1).
Advantages in tough and routine cases
The ZeptoLink can help to simplify tough cataract cases such as small pupils where the tip of the handpiece can be placed under the iris to create a 5.4 mm anterior capsulotomy even if the dilation is just 4 mm. For traumatic cases, particularly where there is anterior lens capsule fibrosis, the ZeptoLink device can make a precise opening despite the preexisting capsular scarring (Figure 2). That is something that we just cannot achieve with a capsulorrhexis.
For routine cases, the ZeptoLink can bring a level of consistency and precision that is difficult to produce by hand. While many surgeons use the pupil margin to assist in sizing of the capsulorrhexis, this can lead to issues when the patient has a variable degree of dilation and a non-average corneal diameter. In a recent case, a highly myopic patient with a 13 mm corneal diameter and an elongated axial length, the ZeptoLink device was used to create a precise 5.1 mm diameter capsular opening. While initially this capsular opening seemed small compared with the large dilation and corneal diameter, at the end of the case, there was a perfect overlap of the 6 mm IOL optic (Figure 3).
Years ago, when first using the Zepto device, I was impressed with the level of precision for creating an instant capsular opening in milliseconds. At the time, that required an assistant to help control a separate console that created the vacuum to hold the anterior lens capsule and then deliver the pulse of energy. With the new ZeptoLink device, which is integrated with any existing phaco machine, the vacuum is provided by the phaco platform and controlled by the surgeon using the same phaco foot pedal. This makes the precision pulse capsulotomy procedure intuitive and simple without requiring any additional space in the operating room. I anticipate that the ZeptoLink will become a welcome addition for cataract surgery for many ophthalmologists.
A video of these surgeries can be found at https://cataractcoach.com/?s=zepto.
- For more information:
- Uday Devgan, MD, in private practice at Devgan Eye Surgery and a partner at Specialty Surgical Center in Beverly Hills, California, can be reached at devgan@gmail.com; website: www.CataractCoach.com.
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