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Zeiss VisuMax/MEL for LASIK and KeratoplastyWilliam W. Culbertson, MD;Bascom Palmer Eye Institute, Miami, FL1
VisuMax Femtosecond Laser PrecisionLow IOPLow energyGentle on patientMinimal applanationSMILELASIK flapsKeratoplastyICR2
Femtosecond TechnologySpherical contact interface to cornea Corneal fixation assures a betterfixation than scleral fixation designs Precise treatment positioning Different sizes to adapt to individualcornea dimension Low suction pressure Minimal applanation Minimal IOP increase No vision loss during suction*Page 3
VisuMax Femtosecond SystemFeatures of Visumax Flap:Predictable and accurate flap thickness (80 µm – 220 µm) and dimensionFlap bed parallel to corneal surface (Diameter 10.7 mm, applanated)Step side cut angle (selectable between 45 degree to 135 degree)Better fit for flap repositioningIncreased safety
VisuMax Femtosecond SystemOCT flap imagingHomogeneous flap thicknessRegular interfaceVisante OCTHD OCT
History of the Zeiss excimer laser 1986 MEL 50 introduced Zeiss has been in therefractive laserbusiness for 27 years 1989 MEL 60 1997 MEL 70 2003 MEL 80 2013 International launchof MEL 9014.12.20166
MEL-80MEL-80 Excimer laser Smart Pulse technology Developed to control every laser pulse at high speed repetition rate (250Hz) Peripheral Pulse Control to compensate for energy reflection Very small spot size (0.7mm) Gaussian Beam Profile Closed Loop Controlled Energy Beam Delivery System Active Eye Tracking (1060 Hz) Optics Shielded and Vacuum Flushed 110VPage 7
MEL 80 Best FDA clinical results (August 2006)93% 20/2041% 20/15 Myopic approval -7D sphereHyperopic approval 5D sphereAstigmatism approval 3D cylinderMRSE -8 D We can treat 95% of population base with currentapprovalsPage 8
MEL 90 Excimer TechnologyThe MEL 90 is the only flying spot excimer laserthat builds on a legacy of 10 years of technicalexperience and excellent clinical outcomes The reliability of MEL 80 the highclinical performance MEL 90 Fastest intraoperative ablation on themarket with its 500 Hz capabilityCarl Zeiss Meditec, Inc., Amy Wong, MarComm8/6/20149
POWER, ACCURACY, TIMEMEL 90 powerWith its unique FLEXIQUENCE switch function(250 Hz and 500 Hz operation) and additional configurationoptions the MEL 90 is a true customized power package.(FLEXIQUENCE - Frequency switch function 250 Hz/ 500 Hz)MEL 90 accuracyThe Triple-A profile enables fast, safe and highly precisetreatments. Its excellent predictability, even with astigmatismand higher ametropias, offers additional safety.(Triple-A Advanced Ablation Algorithm)MEL 90 timeWhen performing LASIK for myopia at 500 Hz, MEL 90 canintra-operatively ablate 1 diopter as little as 1.3 seconds.Intuitive system guidance and speedy treatment planning allowfor additional time savings.(Intra-operative speed of 1.3 seconds per diopter (Myopia, LASIK, 500 Hz, OZ: 6 mm))Carl Zeiss Meditec, Inc., Amy Wong, MarComm8/6/201410
INTELLIGENCE, ATMOSPHERE, OUTCOMESMEL 90 intelligenceThe Triple-A profile is based on an intelligent combinationof refractive correction and clever energy distribution.It enables an aspherically optimized design with minimalablation depth. As a result, treatments are faster and save tissue.MEL 90 atmosphereThe unique, sensor-controlled CCA plume removal systemsupports optimal atmospheric conditions around thepatient‘s eye – thereby also significantly improvingthe predictability of the results.MEL 90 outcomesThe MEL 90 can be precisely tailored to the individual needsof the modern refractive surgical practice. Its preinstalledfunctions also offer surgeons optimal support forachieving excellent treatment results.Carl Zeiss Meditec, Inc., Amy Wong, MarComm8/6/201411
Combination with VisuMaxFastest excimer-femtosecond combo on the market Real time bilateral femto-LASIKusing VisuMax and MEL: 8:30minutes No platform extension required 90 and 180 setup Seamless data transferCarl Zeiss Meditec, Inc., Amy Wong, MarComm8/6/201412
Clinical Trial Results for MEL 90Highlyaccurate andpredictableoutcomes forall ranges13
LASIK with Visumax with MEL - 80
VisuMax Keratoplasty
VisuMax Femtosecond SystemKeratoplasty – range of clinical applicationsSurgical proceduresPTKPhototherapeutic Keratomileusis(excimer laser domain)ALK Anterior Lamellar KeratoplastyDLK Deep (Anterior) Lamellar KeratoplastyPKP Penetrating KeratoplastyPLK Posterior Lamellar KeratoplastyDSEK Descemet Stripping Endothelial KeratoplastyDALK
Corneal Structure vs Bubble FormationThe upper layer collagen is denser, thinner and more compactThe lower layer collagen is less dense, thicker and less compact
Corneal Structure vs Bubble Formation100um Thickness300um Thickness200um Thickness450um Thickness
Recommended Energy Setting for KeratoplastyALK & DALK (Transparent Cornea) 100um Thickness: 110nJ-130nJ (3.0/3.0/1.5) 200um Thickness: 130nJ-150nJ (3.0/3.0/1.5) 300um Thickness: 200nJ-230nJ (1.6/1.6/1.5) 400um Thickness: 230nJ-280nJ (1.6/1.6/1.5)PKP Standard Mode: 280nJ - 300nJ (1.5/1.5) Fast Mode: 320nJ - 340nJ (2.0/2.0)
Circumferential deep foldscaused by applanation
Engagement/Attachment:Intralase
Engagement/Attachment:FS - 200
Engagement/Attachment:VisumaxCross section of the contact glass
Interface and Transparency Outcomes
VisuMax Femtosecond SystemUser programmable parameters for Keratoplasty Lamellar intrastromal cut parallel to the anterior surfaceof the cornea Lamellar incisions ranging from 50 µm up to 650 µmdepth for anterior lamellar keratoplasty PKP: Penetrating Keratoplasty (sidecut) Max. appro 700 µm @ 8mm Diameter range: 5.5 - 9.5 mm Straight sidecut with adjustable sidecut angle 45 - 135 Individual programming of all treatment parameters fordonor and recipient treatment
VisuMax Femtosecond SystemKeratoplasty treatment planning user interface
VisuMax Femtosecond SystemDonor cornea handling – easy and flexible solution Adapter to headrest of patientbed Cover plate can be sterilized
VisuMax Femtosecond SystemCorneal interface designed donor cornea preparationDonor cornea Special KP treatment pack No suction ring Designed to avoid mechanical interference withmost artificial anterior chambers modelsPatient eye Regular Treatment Pack as used for flap (S/M/L)Artificial anterior chamber Dynamic pressure control -BSS Model Barron (katena, inc) is recommended
VisuMax Femtosecond SystemImpressions on clinical performance VisuMax workstation setup in sterile ORVisuMax microscope for manual surgery and suturing
VisuMax Femtosecond SystemKeratoplasty treatment planning user interfacePKP (Donor & Receipient) Donor Curvature: 7.7mm (default) Receipient: individual K reading Donor Diameter Receipient ( 0.2mm) Actual Diameter Nominal ( 0.4mm) Outer diameter Inner diameter (1mm) Side cut angle: 90 (less astigmatism) Cornea should be transparent Thickness pachy approx 50-100micron Donor uses KP treatment pack Receipent uses normal treatment pack
VisuMax Femtosecond SystemSidecut angle of PKP
VisuMax Femtosecond SystemExample Penetrating KP Separation and removal of donor button
VisuMax Femtosecond SystemExample Deep anterior lamellar KP 480 µm deep lamellar incision in the course of DALK
VisuMax Femtosecond SystemVisante OCT scans post-opDALK – ant. lam. KPDSEK – post. lam. KP
VisuMax Femtosecond SystemHistology of femtosecond incision Deep lamellar graftIncision depth: 450 µmLaser settings: 340 / 1.8Incision time:97 sec.Penetrating graftIncision depth: 715 µmLaser settings: 360 / 1.8Incision time:48 sec.
ALK with VisumaxAnterior scar 6 months postinfectious keratitisPre-op Vision: 20/200
ALK Visumax
ALK with VisumaxAnterior scar 6 months postinfectious keratitisPost-op Vision: 20/40 sc
Zeiss VisuMax/MEL for LASIK and Keratoplasty
When performing LASIK for myopia at 500 Hz, MEL 90 can intra-operatively ablate 1 diopter as little as 1.3 seconds. Intuitive system guidance and speedy treatment planning allow for additional time savings. (Intra-operative speed of 1.3 seconds per diopter (Myopia, LASIK, 500 Hz, OZ: 6 mm))
