Envision the exceptional with the new ZEISS Retina Workflow

0:00–2:46 | Overview and OCTA applications in DR/DME
Presenting OCTA role in confirming disease severity, evaluating microaneurysms, distinguishing neovascularization types, assessing capillary closure, and tracking progression, along with limitations in DME and the importance of wider field-of-view imaging.

2:46–5:25 | Clinical staging systems and disease progression evaluation
Discussing OCTA for DR detection – FAZ alterations, reduced capillary density, vessel morphology changes – before clinical lesions appear. In advanced stages, OCTA clearly visualizes ischemia progression and epiretinal neovascularization without invasive imaging.

5:25–8:52 | Comprehensive OCT assessment and fluid characterization description
Exploring OCT as gold standard for macular evaluation, covering parameters beyond central thickness: macular volume, edema patterns, and vitreomacular relationships. Key biomarkers include DRIL, hyperreflective foci, and vitreomacular traction. Intraretinal fluid correlates with worse outcomes while subretinal fluid indicates inflammatory phenotype with better prognosis. AI enables precise volumetric quantification and precise fluid localization.

9:03–13:04 | Neuroinflammation markers and ischemia assessment
Microaneurysm appearance indicates leakage vs. ischemia patterns. Macular ischemia on OCTA correlates with DRIL, reduced retinal sensitivity, and serves as a surrogate for peripheral ischemia – important for evaluating novel therapies.

13:04–end | AI-enhanced retinal imaging highlights ischemia and revascularization potential.
Novel drugs use ultra-widefield imaging and OCTA to evaluate ischemia and retinal revascularization potential. AI enhances imaging analysis across modalities, particularly for automated biomarker quantification, supporting efficient clinical decision-making.

0:00–1:00 | AI sets the stage in retinal imaging
Introduction to artificial intelligence in retinal disorders. Retinal imaging is well suited for AI because images are high resolution and available in large numbers.

1:00–3:03 | Clinical case study 1 - Bilateral AMD with AI-assisted detection
72-year-old patient with reduced visual acuity in both eyes. Multimodal imaging – including fundus photography, OCT, and OCTA – identifies clear neovascular exudative AMD with subretinal fluid, hyperreflective material, and neovascularization in the left eye. ZEISS CIRRUS PathFinder AI identifies subtle type 1 macular neovascularization with subretinal fluid in the right eye where the initial B-scan shows only drusenoid PEDs. Includes validation study details (600 volumetric OCT scans) demonstrating good sensitivity and specificity of the AI system.

3:00–end | Clinical case study 2 - Post-treatment AMD with fibrosis
Patient with long-standing neovascular AMD treated with anti-VEGF in both eyes, who developed atrophy and fibrosis with low visual acuity, leading to treatment discontinuation. The case demonstrates OCT findings of hyperreflective subretinal material (fibrosis) and RPE absence. Emphasis on the clinical importance of detecting macular hemorrhage as a biomarker requiring treatment resumption when anti-VEGF therapy has been stopped.

0:05–0:56 | A decade of vitreoretinal visualization: evolution in the details
Reflection on 10 years of intraoperative OCT experience, from early ZEISS systems to today's platform. While the hardware may look similar at first glance, subtle advances in visualization technology have meaningfully changed what surgeons can see and do.

0:57–1:43 | What's new: 3D/4K, digital filters, and improved OCT
The latest system combines a hybrid 3D/4K mode with possibility to instantly switch between oculars and screen, customizable digital RGB filters, enhanced intraoperative OCT with foot-pedal-controlled scan positioning, improved depth of field, and contactless wide-field visualization.

1:44–3:27 | Digital filters: customizing color to reveal tissue
RGB filters – red/orange, green, and blue – each highlight different intraocular structures. Surgeons can go beyond manufacturer presets: one example shows a custom blue filter that helps improve membrane visualization during macular peeling, supporting low-light surgery and intraoperative support with intraoperative OCT.

3:28–4:23 | Orange vs. green: enhancing the subretinal space
Switching from green to orange filter enhances the subretinal space and choroidal detail, making it easier to target subretinal injections precisely. Demonstrated in a gene therapy case, intraoperative OCT can confirm bleb placement and monitoring for bleeding without introducing optical aberrations.

4:24–5:18 | Working under air: solving the shining problem with blue filters
A common concern with 3D visualization is glare when working under air. Custom blue filters help reduce this obstacle – laser treatment and tissue detail remain visible even under air, and OCT image quality is comparable to BSS conditions.

5:19–5:53 | Small pupils, stable depth of field: retinal detachment under challenging conditions
In a case complicated by pupil shutdown post-phaco, the system's stable depth of focus supported wide-field retinal visualization through a very small pupil – without constant refocusing – enabling safe, effective surgery without the need for iris hooks.

0:05–1:32 | Indications for subretinal injections
Subretinal injections cover three indications:

• Subretinal hemorrhage + rt-PA: Most forgiving; blood between retina and RPE gives good working margin.
• Large macular holes: Requires iatrogenic parafoveal detachment; volume control is critical to avoid connecting to the hole.
• Gene therapy: Most demanding and requires precise delivery, immune response prevention, and no waste of costly volumes.

Gene therapy can be approached with three strategies: gene augmentation or repair for retinal dystrophies; delivery of instructions for inhibitor synthesis (e.g. antibodies); and RPE-cell-based production of active substances in AMD.

1:33–3:13 | Five steps for successful subretinal gene therapy

The procedure follows five steps:

• Posterior vitreous detachment (triamcinolone-assisted)
• Retinotomy
• Optional ILM peeling to reduce tissue resistance
• Subretinal injection by using a 41-gauge cannula (manual or foot-pedal,)
• Tamponade and postoperative supine positioning of patient

3:14–5:03 | The DORC EVA INICIO injection system in practice
DORC EVA INICIO, developed for DORC EVA NEXUS, the first approved ophthalmic microinjection system, allows for assistant-free delivery of microinjections with precise surgeon control via the footswitch. Intraoperative OCT helps confirm subretinal placement, distinguish subretinal from intraretinal spread, and monitor bleb expansion, with the goal of maximizing posterior pole detachment for broad RPE coverage by the viral vector.

5:05–6:00 | Complications and the importance of controlled injection
Potential complications include chorioretinal atrophy and localized atrophy at the retinotomy site, highlighting the need for controlled injection systems. Injection speed is a key risk factor: bleb propagation requires ~0.34 bar, bubble formation ~0.62 bar, and rates of 1–3 ml/s are not universally safe.

6:00–7:51 | The EVA NEXUS surgical platform
The DORC EVA NEXUS is a surgical platform for posterior, anterior, and combined surgery. Its VacuFlow VTi dual-mode fluidics with Flow and Vacuum modes deliver precise flow control (±0.1 cc), fast vacuum response, and pulsation-free performance. Key instruments include the two-dimensional cutter DORC TDC VELOCE, DORC EVA AVETA trocar system, dedicated foot pedal, and DORC EVA INICIO.

7:51–10:15 | Five Reasons to choose the ZEISS ARTEVO 850

• Hybrid System: Seamless switching between 3D and conventional microscopy; settings auto-adapt to anterior or posterior segment surgery; no nurse assistance needed; lateral observers see no double vision.
• Augmented Reality: User-friendly intraoperative overlays; includes astigmatism correction through Callisto integration.
• Intraoperative OCT: Enables real-time decision-making; supports macula-on vs. macula-off assessment in retinal detachment surgery, confirms macular hole closure, and guides gene therapy procedures.
• Digital Color Assistant (DCA): Color enhancement technology that accentuates anatomical details such as membranes and vitreous structures
• Digital Integration into the ZEISS Medical Ecosystem: Connects preoperative assessment, intraoperative treatment, and postoperative follow-up for measurable workflow efficiency gains.

0:05–1:22 | From bench research to the operating theatre: How cutter size and design influence the flow balance
Bench test assessments of the performance of vitreous cutters assume that double-cut technology, together with high-flow infusion and smart IOP control can enhance safety and efficiency during vitrectomy surgery.
With the two-dimensional cutter of the DORC TDC VELOCE the volumetric flow per cycle increases compared to a single-blade cutter. At the same time, acceleration values are smaller for a given flow, implying overall performance is a balance: larger volume per stroke vs. lower per-blade acceleration, which makes flow limitation the key parameter to manage.

1:24–3:07 | Vacuum control with 25-gauge: finding the optimal range
Live parameters show how vacuum affects flow stability in 25g vitrectomy. At vacuum 400 / flow limit 15 cc/min, delta flow runs 11–15 cc/min which is functional, but not ideal. Raising to vacuum 600 / 20 cc/min delivers steady flow, lower traction, and better efficiency, as the wider vacuum range absorbs variation. Pushing the limit to 30 cc/min gains efficiency but sacrifices steadiness and safety.

3:08–4:26 | Flow control mode with 25-gauge: aspiration as the key lever
In flow control mode, the set flow rate is capped from the start. At 15 cc/min with 400 mmHg aspiration, a flow delta persists – raising aspiration to 600 mmHg closes that gap, delivering a true steady 15 cc/min for both BSS and vitreous. At 20 cc/min with only 400 mmHg, the delta widens (7–20 cc/min), driving high traction and poor efficiency. Pairing 20 cc/min with 600 mmHg resolves this: steady flow, low traction, high efficiency.

4:26–5:16 | 27-gauge settings: flow control at 600 mmHg is the sweet spot
With 27-gauge, vacuum control alone falls short – even at 600 mmHg, the flow delta swings from 4 to 28 cc/min. Flow control mode changes this: 12 cc/min paired with 600 mmHg delivers steady flow, low traction, and very high efficiency – a notably strong result for 27-gauge.

5:17–6:53 | IOP and compensation during intraocular injection
Intraocular injections (perfluorocarbon liquid, dyes, etc.) cause significant IOP spikes – live pig eye measurements show surges of 200–300 mmHg during scleral indentation and injection, far above the physiological perfusion range of 50–60 mmHg. Dynamic compensation holds pressure within ±10 mmHg of target, applying negative compensation during injection to actively offset the rise – a key protective mechanism.

6:53–7:43 | Practical conclusions and recommended settings
Core principle: maintain high suction (600 mmHg); set the flow limit based on probe size and available suction

• 25-gauge – both (flow and vacuum) modes deliver similar results. In Vacuum mode vacuum raise time is faster.
• 27-gauge – Flow control is the preferred approach.