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Dr. Ike Ahmed performs a capsulotomy using the ZEPTO® precision capsulotomy system. Video 1 of 2
Dr. Ike Ahmed performs a capsulotomy using the ZEPTO® precision capsulotomy system. Video 2 of 2
Centricity Vision ZEPTO® Visual Axis Centration Animation
Dr. Vance Thompson: ZEPTO® with Multifocal
Dr. Vance Thompson: ZEPTO® with Trifocal
Dr. Vance Thompson: ZEPTO® with Trifocal ASCRS Symposium – Boston
Dr. Vance Thompson: ZEPTO® with Light Adjustable Lens
Dr. Florian Kretz: ZEPTO® Toric Trifocal
Dr. Florian Kretz: ZEPTO® with miLoop
Dr. Vance Thompson: ZEPTO® with Monofocal
Dr. Rob Petrarca: ZEPTO® with Monofocal
Dr. David Castillejos: ZEPTO® with Monofocal
Dr. David Chang: 20 ZEPTO® Complicated Cataract Cases
Dr. David Chang: ZEPTO® capsulotomy in the setting of a calcified anterior capsular plaque
Dr. Kevin Waltz: ZEPTO® innovative technology relieves pressure in intumescent cataracts
Dr. David Chang: ZEPTO® in Floppy Iris Syndrome
Dr. Rachel Lieberman: Small Pupil ZEPTO® Case
The current version of ZEPTO® produces a median capsulotomy diameter of 5.2 mm.
No, the disposable ZEPTO® handpiece is single-use only. Attempted re-use will not result in another capsulotomy. Do not re-sterilize, autoclave or reuse, and discard opened unused product.
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Care should be exercised depending on the clinical situation. In first cases, the recommended chamber depth is 2.5-3.75 mm.
The surgeon may compensate for a deeper chamber by choosing a more posterior location for the primary incision and by minimizing OVD use. Surgical judgment should be used in all cases because ZEPTO® must be able to reach and appose to the capsule surface to produce a capsulotomy.
Yes, with experience the elongated tip may be slipped under the iris distally and then opened up to slide under the iris 360°. The silicone suction cup shields the iris tissue from the nitinol ring. In first cases, it is not recommended to use ZEPTO® in poorly dilated pupils.
Yes, ZEPTO® may be used with pupil expansion devices.
Pediatric cases are contraindicated at this time.
The current version of ZEPTO® is not designed to reach into the capsular bag to create a posterior capsulotomy and should not be used for this purpose.
Yes, ZEPTO® is designed to be used through a clear corneal incision.
We do not recommend using ZEPTO® without OVD in the anterior chamber. Although ZEPTO® can create high quality capsulotomies in the presence of BSS only, there will be no bubble flow that is normally present in the OVD as suction is developing. As a result, it is difficult for the surgeon to confirm full suction visually.
All OVDs with a viscosity less than or equal to 300,000 mPas (or 300,000 cps) can be used. OVD Guide
Based on the experience from thousands of cases worldwide, it is strongly recommended that the surgeon starts with routine, uncomplicated cases with an anterior chamber depth of 2.5 mm to 3.75 mm and a pupil of at least 7 mm in diameter. Once the basics of positioning horizontally on the capsular plane, observing bubble flow for full suction, and proper ZEPTO® release and float-off have been mastered, more challenging cases may be undertaken.
After retracting the pushrod and allowing the tip to recircularize, leave the pushrod in the neck of the device with the pushrod tip just outside of the flange/silicone skirt. The pushrod provides rigidity to the neck, facilitating the tip to be gently moved on the anterior capsule in a circular fashion to ensure complete capsule apposition. After the desired capsulotomy position is achieved and suction is initiated, retract the pushrod fully to the wide portion of the ZEPTO® neck. Neglecting to fully retract the pushrod from the neck may result in less-than-maximum suction which may cause complications.
The ZEPTO® suction cup has a 6.10 mm diameter. For pupil diameters ranging between 5.5 and 6.5 mm, iris tissue can be close to the suction cup and can potentially be trapped by the suction.
To release trapped iris tissue, the circulator assistant should first push the “Reset” button on the power console to stop the vacuum. Then advance the syringe fluid dispenser forward as is normally performed to release suction. Note that the OVD may cause the iris to remain sticking to the suction cup even after release. If needed, the iris tissue may be freed by a second instrument through the sideport incision or by introducing more OVD to separate iris tissue from the suction cup. The tip may then be repositioned after the surgical assistant resets the roller syringe into its initial start position.
It is helpful to stabilize the eye when inserting the ZEPTO® tip through the incision. Use of countertraction with a Thornton ring or .12 forceps, 90° or 180° from the wound is recommended. In addition, place a small amount of OVD just outside the incision and/or on the elongated ZEPTO® tip to lubricate entry. Gentle pressure posteriorly will also facilitate entry of the tip through the wound.
ZEPTO® is designed to consistently and automatically create circular, strong and visual axis-centered capsulotomies for precise surgical outcomes. Its action hinges on achieving an optimal level of suction to produce even and complete capsule apposition to the nitinol capsulotomy ring. Surgeons experienced with ZEPTO® universally advise allowing a few extra seconds after suction has been achieved and bubbles have stopped moving before delivering energy to create the capsulotomy. Likewise, after capsulotomy creation, surgeons recommend confirming ZEPTO® release from the capsule with an upward and forward motion, observing some OVD exit at the incision. This prevents ZEPTO® removal before full release from the capsule, which can inadvertently damage the capsulotomy. Consistent practice of the ZEPTO® procedure guidelines will help ensure great outcomes every time.