Posted on December 26, 2017
Cataract or clouding of the natural lens of the eye is an integral part of ageing, and results in a slowly progressive decrease in vision, especially in people older than sixty years of age. The only way to get rid of a cataract, and to restore vision, is to surgically remove the natural lens of the eye, and replace it with an artificial one. Cataract surgery has become increasingly common and safe, given the rapid advances in technology over the last two decades. Phacoemulsification is the most common method of modern cataract surgery, and it is a safe and effective method of cataract removal, enabling intraocular lens (called IOL, or artificial lens) inside the eye, with an incision as small as 1.5mm.
During phacoemulsification, which is the most advanced form of cataract surgery, the surgeon creates a small incision into the cornea which is the clear part of the eye. The surgeon then creates a circular hole in the anterior part of the capsule of the natural lens, by a procedure called capsulotomy. After this, he or she proceeds to liquefy the cataractous lens using phacoemulsification (which is a form of ultrasound energy). He or she then removes the resultant liquid using a handheld vacuum suction device. In the resultant empty lens capsule “bag”, the surgeon then inserts the artificial IOL, the power of which is customised to the patients’ eye.
All of the steps of phacoemulsification are standardised, and critical to the surgery. The differentiator in surgical outcomes, more often than not, is the capsulotomy. The capsulotomy is the one step in the operation that is crucial to determining patient outcomes, guaranteeing procedural success, and minimising potential negative side effects. That is, the difference between excellent vision and perfect vision depends upon how smooth the capsulotomy is.
In conventional phacoemulsification, capsulotomy, also called capsulorhexis, is done manually using forceps or a bent needle. Usually, this capsulotomy is not perfectly circular (which is the most stable shape) and in some cases, the capsulotomy may “run” to one side, resulting in a tear of the capsular bag. This means that the IOL implanted may not as stable as it should be.
To circumvent this error which is inherent to a manual procedure, femtosecond laser cataract surgery was developed, which uses a laser beam to create this capsulotomy, eliminating the chances of human error and possible complications. This technique, automates the capsulotomy process, but, it also adds a considerable cost, and time to the duration of surgery.
A novel technique called “Zepto Capsulotomy Device for cataract surgery” was developed around a decade ago, which is significantly cheaper, results in a stronger capsulotomy, provides fewer logistical challenges and reduces overall surgical time in comparison to Femtosecond laser assisted cataract surgery. Also Femtosecond laser cannot be used with ease in patients with corneal opacities or small pupils. The device also makes the surgery safer and more predictable, and can especially be useful in more complex surgeries.
The Zepto Pulse cataract device is disposable and handheld, and attached to a state of the art console. It is made of Nitinol alloy, which can be inserted through an almost 2mm incision of the cornea, and uses fast, low-energy pulses of direct current to perform a perfectly centred and perfectly circular capsulotomy, each time. The device also has a built in vacuum that helps the surgeon align the capsulotomy perfectly.
Proper centration and perfectly smooth capsulotomy shape mean that the IOL is aligned directly with the eyes visual axis, which results in better, sharper vision with less incidence of haloes, glare and ghost images. In addition, Zepto cataract device saves about 120-15 minutes of surgical time in comparison to Femtosecond laser cataract surgery, which is also critical to management of cataract patients.
Zepto Cataract surgery is the latest advancement in automated cataract surgery which enhances the precision, safety & final visual outcomes, without a significantly higher cost to the patient. Especially in eyes with corneal opacities and small pupils, as also patients with co-morbidities who are not good candidates for femtosecond laser cataract surgery, Zepto Pulse Cataract Surgery can dramatically improve visual results. In other complicated cases also like intumescent cataract, children with cataract, subluxated lens (in which the capsular bag is itself not stable due to trauma or disease) and in cases with calcification of the capsular bag, Zepto Pulse technology can make cataract surgery far safer with better visual results.
After obtaining the CE Mark in Europe, Zepto was launched outside the US market in 2017. The first Zepto Pulse Cataract surgery, popularly called Zepto Cataract, was performed by Dr. Sanjay Chaudhary at Eye7 Daryaganj, in the same year.