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Zeiss VisuMax/MEL for LASIK and Keratoplasty 1 William W. Culbertson, MD; Bascom Palmer Eye Institute, Miami, FL
Zeiss VisuMax/MEL for LASIK and Keratoplasty
1
William W. Culbertson, MD;
Bascom Palmer Eye Institute, Miami, FL
VisuMax Femtosecond Laser
2
• Precision
• Low IOP
• Low energy
• Gentle on patient
• Minimal applanation
• SMILE
• LASIK flaps
• Keratoplasty
• ICR
Femtosecond Technology
3
Spherical contact interface to cornea
• Corneal fixation assures a better
fixation than scleral fixation designs
• Precise treatment positioning
• Different sizes to adapt to individual
cornea dimension
• Low suction pressure
• Minimal applanation
• Minimal IOP increase
• No vision loss during suction*
Page 3
Predictable and accurate flap thickness (80 µm – 220 µm) and dimension
Flap 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 repositioning
Increased safety
VisuMax Femtosecond System
Features of Visumax Flap:
VisuMax Femtosecond System OCT flap imaging Homogeneous flap thickness
Regular interface
HD OCT
Visante OCT
History of the Zeiss excimer laser
• 1986 MEL 50 introduced
• Zeiss has been in the
refractive laser
business for 27+
years
• 1989 MEL 60
• 1997 MEL 70
• 2003 MEL 80
• 2013 International launch
of MEL 90
14.12.2016 6
MEL-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
• 110V
MEL-80
Page 7
MEL 80
• Best FDA clinical results (August 2006)
93% 20/20
41% 20/15
• Myopic approval -7D sphere
• Hyperopic approval +5D sphere
• Astigmatism approval 3D cylinder
• MRSE -8 D
• We can treat 95% of population base with current
approvals
Page 8
MEL 90 Excimer Technology
8/6/2014 9 Carl Zeiss Meditec, Inc., Amy Wong, MarComm
The MEL 90 is the only flying spot excimer laser
that builds on a legacy of 10 years of technical
experience and excellent clinical outcomes
The reliability of MEL 80 + the high
clinical performance = MEL 90
Fastest intraoperative ablation on the
market with its 500 Hz capability
POWER, ACCURACY, TIME
8/6/2014 10 Carl Zeiss Meditec, Inc., Amy Wong, MarComm
MEL 90 power With its unique FLEXIQUENCE switch function
(250 Hz and 500 Hz operation) and additional configuration
options the MEL 90 is a true customized power package.
(FLEXIQUENCE® - Frequency switch function 250 Hz/ 500 Hz)
MEL 90 accuracy The Triple-A profile enables fast, safe and highly precise
treatments. Its excellent predictability, even with astigmatism
and higher ametropias, offers additional safety.
(Triple-A Advanced Ablation Algorithm)
MEL 90 time 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))
INTELLIGENCE, ATMOSPHERE, OUTCOMES
8/6/2014 11 Carl Zeiss Meditec, Inc., Amy Wong, MarComm
MEL 90 intelligence The Triple-A profile is based on an intelligent combination
of refractive correction and clever energy distribution.
It enables an aspherically optimized design with minimal
ablation depth. As a result, treatments are faster and save tissue.
MEL 90 atmosphere The unique, sensor-controlled CCA+ plume removal system
supports optimal atmospheric conditions around the
patient‘s eye – thereby also significantly improving
the predictability of the results..
MEL 90 outcomes The MEL 90 can be precisely tailored to the individual needs
of the modern refractive surgical practice. Its preinstalled
functions also offer surgeons optimal support for
achieving excellent treatment results.
Combination with VisuMax
8/6/2014 12 Carl Zeiss Meditec, Inc., Amy Wong, MarComm
Real time bilateral femto-LASIK
using VisuMax and MEL: 8:30
minutes
• No platform extension required
• 90° and 180° setup
• Seamless data transfer
Fastest excimer-femtosecond combo on the market
Clinical Trial Results for MEL 90
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Highly
accurate and
predictable
outcomes for
all ranges
LASIK with Visumax with MEL - 80
VisuMax Keratoplasty
VisuMax Femtosecond System Keratoplasty – range of clinical applications
Surgical procedures
PTK Phototherapeutic Keratomileusis
(excimer laser domain)
ALK Anterior Lamellar Keratoplasty
DLK Deep (Anterior) Lamellar Keratoplasty
PKP Penetrating Keratoplasty
PLK Posterior Lamellar Keratoplasty
DSEK Descemet Stripping Endothelial Keratoplasty
DALK
Corneal Structure vs Bubble Formation
The upper layer collagen is denser, thinner and more compact
The lower layer collagen is less dense, thicker and less compact
Corneal Structure vs Bubble Formation
100um Thickness 200um Thickness
300um Thickness 450um Thickness
Recommended Energy Setting for Keratoplasty
ALK & 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 folds
caused by applanation
Engagement/Attachment:
Intralase
Engagement/Attachment:
FS - 200
Engagement/Attachment:
Visumax
Cross section of the contact glass
Interface and Transparency Outcomes
VisuMax Femtosecond System User programmable parameters for Keratoplasty
• Lamellar intrastromal cut parallel to the anterior surface
of the cornea
• Lamellar incisions ranging from 50 µm up to 650 µm
depth 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 for
donor and recipient treatment
VisuMax Femtosecond System Keratoplasty treatment planning user interface
VisuMax Femtosecond System Donor cornea handling – easy and flexible solution
• Adapter to headrest of patient
bed
• Cover plate can be sterilized
VisuMax Femtosecond System Corneal interface designed donor cornea preparation
Donor cornea
• Special KP treatment pack
• No suction ring
• Designed to avoid mechanical interference with
most artificial anterior chambers models
Patient 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 System Impressions on clinical performance
• VisuMax workstation setup in sterile OR
• VisuMax microscope for manual surgery and suturing
VisuMax Femtosecond System Keratoplasty treatment planning user interface
PKP (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 System Sidecut angle of PKP
VisuMax Femtosecond System Example Penetrating KP
• Separation and removal of donor button
VisuMax Femtosecond System Example Deep anterior lamellar KP
• 480 µm deep lamellar incision in the course of DALK
VisuMax Femtosecond System Visante OCT scans post-op
DALK – ant. lam. KP DSEK – post. lam. KP
VisuMax Femtosecond System Histology of femtosecond incision
• Deep lamellar graft
• Incision depth: 450 µm
• Laser settings: 340 / 1.8
• Incision time: 97 sec.
• Penetrating graft
• Incision depth: 715 µm
• Laser settings: 360 / 1.8
• Incision time: 48 sec.
ALK with Visumax
Anterior scar 6 months post
infectious keratitis
Pre-op Vision: 20/200
ALK Visumax
ALK with Visumax
Anterior scar 6 months post
infectious keratitis
Post-op Vision: 20/40 sc
Zeiss VisuMax/MEL for LASIK and Keratoplasty
