The Zeiss Quatera 700 boosts confidence and efficiency.

Sometimes, technology advances one small improvement at a time. In other cases, the leap is larger, bringing major benefits.

Arguably, the Zeiss Quatera 700 falls into the second category, representing a large advance in phacoemulsification. “It’s a significant step forward, not just an incremental improvement,” says Y. Ralph Chu, MD, founder and medical director, Chu Vision Institute, Bloomington, Minn.

In this article, we’ll discuss the features that make the device notable, including Automated Ultra-sound Power on Demand, and a digitally integrated surgical workflow. But let’s start with the major improvement, the Zeiss patented Quattro Pump.

INDEPENDENT CONTROL

Historically, phacoemulsification machines fall into two categories, according to Inder Paul Singh, MD, president and head of the glaucoma division of the Eye Centers of Racine and Kenosha, Wis. In flow control or peristaltic systems, the surgeon controls the amount of irrigation or aspiration but can’t independently control vacuum. In vacuum or venturi systems, on the other hand, the surgeon can control vacuum, but the machine automatically controls irrigation. Some devices, notes Dr. Chu, allow the surgeon to choose to use peristaltic in some cases and venturi in other cases.

With the Quattro Pump, the Zeiss Quatera 700 is “able to independently give you control of how much fluid is going in the eye and how much vacuum so you can still control vacuum linearly or independently,” Dr. Singh says. “You don’t need occlusion to build vacuum, but, at the same time, you can sense how much fluid is needed to keep the chamber stable. You can control how much fluid is pumping in real time. Giving you control of fluid and vacuum independently is a unique feature.”

Clinically, notes Dr. Singh, the surgeon can use high vacuum levels, getting the cortical pieces to come to the surgeon and thus be highly efficient. What’s more, the surgeon doesn’t have to use so much fluid to keep the anterior chamber stable. “By having this independent control, Zeiss has been able to keep pressures in the eye lower, use less irrigation, but keep those chambers nice and stable,” says Dr. Singh. “If you can limit the amount of irrigation while keeping the environment stable, you can limit the potential for postoperative corneal edema.”

“You’re actually able to maintain a very stable anterior chamber, which does play out clinically, at very high vacuum levels,” adds Dr. Chu, who says he was the third surgeon to use the device in the United States. Zeiss announced the FDA clearance of the Quatera 700 in April 2022.

Dr. Chu says he has used the Quatera with a vacuum as high as 700 mm Hg. “No other device that I’ve used across all platforms has been able to do that level of vacuum and maintain a stable anterior chamber,” according to Dr. Chu.

ULTRASOUND ON DEMAND

Besides the new pump technology, the Quatera can automatically begin ultrasound only when the tip is occluded and stop when the tip is cleared. Not engaging ultrasound when there is no piece at the tip helps limit the amount of unnecessary ultrasound energy in the anterior chamber, thus having less potential for post-op corneal edema, notes Dr. Singh.

VIDEO

With the integration of a live surgical image on the video screen on the phaco unit itself, technicians can easily observe the procedure from their position. “Therefore, your surgical tech can focus on you and the phaco machine the whole time. What you want as a surgeon is your technician to be able to anticipate what you need next,” says Dr. Singh.

INTEGRATION WITH ZEISS EQUIPMENT

The Quatera can integrate with other Zeiss equipment, such as the Callisto eye digital marking system, Dr. Singh says. The surgeon can navigate the Callisto by using the Quatera phaco pedal. “Now you have full control of not only your phaco machine but also your digital marking,” notes Dr. Singh.

The Quatera can also integrate with the Artevo 3D heads-up display and Veracity cataract planning software. “Being able to see all the phaco parameters on the 3D Artevo screen was truly enlightening,” says Dr. Singh.

QUICK LEARNING CURVE

Dr. Chu and Dr. Singh both report quick learning curves for the Quatera 700. “We found our learning curve to be fewer than five cases,” says Dr. Chu. “By the middle of the first day, after my first four or five cases, I felt really comfortable,” says Dr. Singh.

Because you can independently control fluid and vacuum, you can create a familiar environment at first, according to Dr. Singh. Initially, you can create a peristaltic or a more venturi environment.

“The learning curve can be very, very quick and very comfortable because you can create the environment that the surgeon is used to and then start to slowly change parameters,” says Dr. Singh.

PATIENT SELECTION

The Quatera can be of special benefit for certain types of patients. As a glaucoma specialist, Dr. Singh sees many with hyperopic eyes. For those patients, who don’t have a lot of space within the anterior chamber, keeping the chamber stable and avoiding collapse is especially important, he notes. The device can also be helpful for patients with weak zonules, pseudoexfoliation and floppy irides.

Also, for patients who have a smaller pupil, the Quatera can help remove cortical pieces, notes Dr. Singh. “You can stay close to the anterior capsular edge. You don’t have to go underneath the iris very far to get those cortical fibers to come out because of the vacuum. The pieces truly come to you.”

The Quatera, says Dr. Chu, works well for patients with more complex situations such as floppy iris syndrome or pseudoexfoliation. “It makes those routine cases, and for routine cases, it makes them very, very efficient, very, very smooth.”

GAINING PEACE OF MIND

“I found myself extremely efficient during surgery,” says Dr. Singh. “And I found our corneas look very pristine post-op day one, even in those denser cataracts.”

“Our anecdotal trend is that with the chamber stability, with the more efficient surgeries, I think we’ll see better visual outcomes,” adds Dr. Chu. “I think it will lead to less phaco energy, less phaco surgery time, which always reduces the trauma to the eye, which improves visual acuity earlier in the postoperative period.”

The increased chamber stability, notes Dr. Chu, “definitely gives the surgeon more peace of mind, with no increased learning curve with a more efficient, safe cataract removal.” OM

Disclosures: Dr. Singh is a speaker and consultant for Zeiss.