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Outpatient Surgery Magazine® We can see clearly now An exciting new development in ophthalmic surgery has emerged from an unexpected direction. A very simple but elegant development in operating microscopes promises to make cataract surgery significantly faster and safer, providing better outcomes for eye surgery and greater profitability for surgery facilities. The revolution I'm talking about s called integrated slit illumination, and it's available on Carl Zeiss's new VISU 160 and VISU 210 microscopes. With the turn of a sterile knob, a baffle moves over the microscope's illumination source, changing the shape of the illumination from a circle to a vertical rectangle.
With these crisp anatomical landmarks, illuminated in the most exquisite detail, safety is greatly enhanced. I can visualize the prove tip depth exactly. There is no confusion about its location in relation to the posterior capsule. It is possible to dive into the nucleus for more efficient lollipop maneuvers, endonuclear wedge dissection and cheese wire techniques using sideport instruments, with the confidence of avoiding rupture of the posterior capsule. The Xenon light source is new for the specialty of ophthalmology. It is an extremely bright blue/white light. I prefer filtering the scattered light from corneal arcus and white cataracts with the yellow infrared/UV filter. Also, I prefer going back to the standard diffuse round illumination for the I/A mode and capsule polishing mode because these modes are more global maneuvers with more surgically induced movement of the eye. Overall, as these microscopes are introduced into the clinical practice, we will see more optimal results, happier patients, faster OR times, the use of fewer costly items like disposable vitreous cutters, as well as less stress on the surgeon and OR crew. The No. 1 rule of all surgery is obtaining adequate exposure. With the advent of integrated slit illumination, a beautiful new world has unfolded in front of us. The definition of exposure - and possibly the future standard of care - is evolving to a higher level.
By Joseph F. Gravlee, Jr., M.D.
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While the concept and the mechanics are exceedingly simple, the
results are profound. When I first tried the device in the OR,
I was astonished; the best red reflex that I have ever seen.
This is logical because most of the field illumination is coming
from truly reflected light. The onion-like layers of the
crystalline lens appear in high definition. The confined beam
transilluminates the nucleus (much as an ophthalmoscope
transilluminates hyaline drusen of the optic nerve head).
Radiating collagen fibers of the nucleus transmit the light (like
fiber-optic light pipes) and where they bend at the equator, they
glow like the golden rings seen after hydodelination of the nucleus
from the epinucleus.