Zepto Professional Resources | Zepto

Professional Resources

Instructions for use and clinical guides

Video Library

Procedure Animation

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. David Goldman: ZEPTO® with Light Adjustable IOL

Dr. David Goldman: ZEPTO® with Toric IOL

Dr. David Goldman: ZEPTO® with Trifocal IOL

Dr. Vance Thompson: ZEPTO® with Monofocal

Dr. Rob Petrarca: ZEPTO® with Monofocal

Dr. David Castillejos: ZEPTO® with Monofocal

Dr. David Goldman: ZEPTO® with Premium Monofocal IOL - Case 1

Dr. David Goldman: ZEPTO® with Premium Monofocal IOL - Case 2

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

Video Categories

  • Procedure Animation
  • Instructional Resources
  • Premium Cases
  • Monofocal Cases
  • Challenging Cases

Frequently Asked Questions

Questions about this device
  • What capsulotomy sizes are available?

    Our portfolio includes the ZEPTO® handpiece and the ZEPTO Plus™ handpiece for two different capsulotomy sizes.

  • Can ZEPTO® be reused?

    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.

  • What are the enhancements in the latest generation of ZEPTO®?

    ZEPTO® has been enhanced for greater precision, safety and efficiency. Check out whats new >

Questions about use
  • What do I look for when I inspect ZEPTO® at the start of surgery?
    • Ensure the pushrod is engaged with the nitinol ring at the 12 o’clock position – In rare cases, the pushrod may be dislodged from the nitinol ring during shipping or instrument setup. If this is observed, do not use the handpiece. Do not attempt to reset the pushrod as this will damage the nitinol ring.
    • Foreign material – ZEPTO® is thoroughly cleaned prior to packaging and shipment. However, fibers and other foreign material from the surgical environment can occasionally attach to the nitinol ring edge during setup. If this occurs, foreign material may be carefully removed using fine forceps or BSS without touching the suction cup or nitinol ring. If the material is not removable, a new ZEPTO® handpiece should be used.
    • Deformed or damaged nitinol ring and/or broken lead attachment – The ZEPTO® handpiece is shipped with a protective cover over the tip. If physical damage to the nitinol ring and electrical leads are observed, do not use the device.
  • How shallow or deep of a chamber can I use ZEPTO®?

    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.

  • Can ZEPTO® be used in cases with poorly dilated pupils?

    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.

  • Can I use ZEPTO® with pupil expansion devices?

    Yes, ZEPTO® may be used with pupil expansion devices.

  • Can ZEPTO® be used for pediatric capsulotomies?

    Pediatric cases are contraindicated at this time.

  • Can ZEPTO® be used for posterior capsulotomies?

    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.

  • Can I use ZEPTO® through a scleral tunnel?

    Yes, ZEPTO® is designed to be used through a clear corneal incision.

  • Will ZEPTO® work without using OVD?

    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.

  • Which OVD can I use?

    All OVDs with a viscosity less than or equal to 300,000 mPas (or 300,000 cps) can be used. OVD Guide

Questions about surgical considerations and recommendations
  • What type of surgical cases should I start with?

    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.

  • What is the best way to bring ZEPTO® in the desired position for capsulotomy creation?

    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.

  • Why do I need to be careful with pupils between 5.5 and 6.5 mm in diameter?

    The ZEPTO® handpiece suction cup has a 5.9 mm diameter and the ZEPTO Plus™ handpiece suction cup has a 6.2 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.

    • For pupils smaller than 5.5 mm, ZEPTO® can be slid under the iris before suction is initiated and there is no danger of iris tissue being trapped by the suction.
    • For pupils larger than 6.5 mm, the iris tissue will not be in close proximity to the suction cup.
  • What do I do if the iris is trapped during 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.

  • Any recommendations for tip entry through the corneal incision?

    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.

  • How can I get consistent results every time?

    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.