Device offers superior visualization during surgeries

The Zeiss Artevo 800 is the first digital microscope for use in ophthalmology and is the most advanced microscope from Zeiss for all ophthalmic surgical applications. According to the company, computers and visualization technology reached a level of performance that allowed it to turn a digital microscope into a product with capabilities surpassing those of analog microscopes.

Although analog microscopes have reached superb optical quality, they still leave surgeons and operating teams with room for improvement regarding depth of field, light intensity, digital assistance overlays, patient information, and ergonomics. A more fluent workflow through digital data transmission is also desirable. According to Zeiss, the Artevo 800 addresses all of these points.

Brandon D. Ayres, MD, a cornea specialist with Ophthalmic Partners of Pennsylvania and the cornea service at Wills Eye Hospital, both in Philadelphia, used the Artevo 800 on his patients on a trial basis. He says the microscope provides excellent visualization of the surgical field. “It was critical in complex cases and simplified some others by unlocking me from the microscope oculars," he says.

FEATURES AND BENEFITS

The advantages of the Artevo 800 can be summarized in two words: seeing more. This is achieved by DigitalOptics, an optical concept optimized for digital visualization. These optics provide superior visualization in resolution, unmatched depth of field, drastically reduced light intensity requirements, and real color impression for increased certainty, according to Zeiss.

Furthermore, AdVision adds digital assistance and information to the surgeon’s vision in real time, so they never miss a detail. Cataract assistance functions, intraoperative OCT, and patient information cloud connectivity allows physicians to access required data from anywhere with integration into the Zeiss Cataract Suite.

Finally, AutoAdjust adapts all visualization parameters to the current surgical situation to deliver peak visualization at all times. The hybrid visualization mode enables surgeons to switch back to the oculars in parallel to the digital visualization during surgery by flicking one sterile switch.

The microscope also integrates data and 3D technology. “This allows surgeons to operate either through the oculars of the scope or in a heads-up position by viewing information on a large 4K display,” Dr. Ayres says. “Depth of focus is significantly enhanced while using the 3D display. It allows surgeons to concentrate more on surgery and less on microscope adjustment. Other advantages include high-resolution intraoperative OCT while using the 3D display, which gives significantly improved real-time OCT visualization of the anterior segment.”

HOW IT WORKS

The Artevo 800 comes in three parts: a microscope stand that contains the digital optics for capturing and processing an image; a 55-inch 3D monitor on a separate stand that can freely be positioned at any desired location in the operating room; and a foot control panel that gives surgeons individual control over the microscope without having to interrupt surgery.

The digital microscope contains the microscope head with a completely redesigned optical concept optimized for digital visualization. It hovers above the patient’s eye and simultaneously captures images with two three-chip 4K cameras. These images are processed and sent as stereoscopic images to its monitor to be viewed with passive polarized glasses.

The images displayed provide viewers with a 3D impression of the surgical field with natural depth and color display. Patient data and operating room device settings as well as overlays of cataract assistance and intraoperative OCT are displayed on the same monitor.

If the surgeon wants to perform surgery using oculars on the microscope, they can activate the hybrid visualization mode. This can be done at any time during surgery, simply by turning a knob that redirects the biggest portion of the light through an analog optical path to the traditional oculars.

“The microscope gave excellent visualization at all levels without any change in hardware or user settings,” Dr. Ayres says. “It was seamless to change from direct visualization to heads-up 3D visualization.”

SPECTRUM OF CARE

Cataract, cornea, and glaucoma surgeons can all use the ophthalmic microscope. The Artevo 800 includes digital assistance (Callisto eye) for cataract surgery and a fundus viewing system (Resight) for posterior interventions. It can be equipped with intraoperative OCT for many different applications. Its motorized tilt specifically benefits glaucoma surgery.

A key benefit of the Artevo 800 is in its surgical flexibility, Dr. Ayres notes, adding that it performed well with pars plana vitrectomy (PPV), cataract surgery, lens exchanges, iris repair, and conjunctival procedures. “It has allowed me to treat a wide range of diagnoses, such as dislocated implants, cataract, iridodialysis, and pterygium without difficulty,” he says. “In some cases, more than one surgeon is necessary to complete an indicated surgical procedure (e.g., PPV with retinal surgeon and then intraocular lens [IOL] placement by anterior segment surgeon for dislocated IOL). When more than one surgeon is needed, the microscope performed well. Each surgeon can decide whether he or she wants to use the scope oculars or 3D display for visualization.”

USER FRIENDLY AND ERGONOMIC

AutoAdjust anticipates a surgeon’s workflow and adjusts device settings automatically. This minimizes the amount of manual adjustments needed and allows surgeons to stay focused on surgery.

By not being forced to look through the oculars, surgeons can have a more comfortable operating position and more freely move their upper body, notes Dr. Ayres. This freedom makes traditionally uncomfortable surgical maneuvers more comfortable.

“One of the biggest benefits in operating in 3D is ergonomics,” says Dr. Ayres. “Surgeons will quickly realize that they’re operating in a much more relaxed position that is easier on the back and shoulders.”

PATIENT BENEFITS

The Artevo 800 allows much less light to be transmitted into the patient’s eye, which reduces light toxicity. The increased depth of field reduces re-focusing requirements, which shortens surgery time and increases a surgeon’s certainty by giving more overview. High resolution resolves tiny particles in order to visualize anatomical structures. The AdVision overlay concept provides additional information about the patient during surgery, enhancing the surgeon’s decision making.

Dr. Ayres says that excellent optics allows for visualization of the anterior segment structures, giving surgeons more confidence to tackle difficult cases and enhancing straightforward cases. Data integration is another benefit with the digital scope.

“The surgical field truly becomes a virtual field where data overlays from biometers, topographers, and surgical tracking systems,” he says. “Having data in real time helps with surgical decision making or toric implant alignment, enhancing patient outcomes.

“The Artevo 800 is equipped for the future of ophthalmology, and has the capability to become the hub of the operating room—connecting the patient, data, and surgeon.” ■