Challenges in CATARACT SURGERY
Dense cataracts
Clinical challenge
Treating dense cataracts – when routine becomes a challenge
Removing hard cataracts can be difficult even for the most experienced cataract surgeons. Patients are typically older, with low visual acuity and coexisting ocular pathologies.1,2
In this case, it is essential to get a detailed understanding of the patient's underlying conditions and prepare for possible challenges during the surgical procedure. Also, informing the patient about their condition is vital to managing expectations.2,3
![]({"small":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/william_wiley_md.ts-1596547967901.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C10%2C360%2C360&w=640&s=b5129ab0b6f87cea5c46701b68d69ce4","large":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/william_wiley_md.ts-1596547967901.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C10%2C360%2C360&w=1280&s=c2439cf8ae9a3a8b5d4d608f6935d720","medium":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/william_wiley_md.ts-1596547967901.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C10%2C360%2C360&w=832&s=283a9e297b636ffe386d686c680b42b2","full":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/william_wiley_md.ts-1596547967901.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C10%2C360%2C360&w=1920&s=cfaba72c611adfe6f6f4b61fd4954eef"})
William F. Wiley, M.D.If you can find a retinal problem before surgery, its a preexisting condition (i.e. the patient owns the problem). If you find the problem after cataract surgery, it‘s considered a complication of the surgery and this puts pressure on us to do pre-operative diagnosis.
Dense cataract workflow challenges
![]({"small":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/preop.ts-1596548134096.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=27%2C21%2C903%2C508&w=640&s=10080d1c6a3b2fafdb9f77db8d0ff1ad","large":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/preop.ts-1596548134096.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=27%2C21%2C903%2C508&w=1280&s=dbefee85b2b79cfb96a084b57391c651","medium":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/preop.ts-1596548134096.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=27%2C21%2C903%2C508&w=832&s=5f8d775aee6e0500018dd8c57872b59c","full":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/preop.ts-1596548134096.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=27%2C21%2C903%2C508&w=1920&s=70eba31f4b4a212f0d9e1d5483bd4b53"})
Assess
A dense cataract is, by its very nature, difficult to penetrate. This makes pre-op cataract evaluation a challenge. Both precise biometric measurement as well as screening for macular pathologies are key to avoid refractive surprises.2,3,4
![]({"small":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/dense-cataract-treat.ts-1611574829943.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C0%2C1915%2C1078&w=640&s=caf2d1cbccd6ba187bbe532f12e33e57","large":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/dense-cataract-treat.ts-1611574829943.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C0%2C1915%2C1078&w=1280&s=1dae0234598ef674f86545d00648804c","medium":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/dense-cataract-treat.ts-1611574829943.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C0%2C1915%2C1078&w=832&s=da962bb75ee646906592e297af49912e","full":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/routine-cataract/dense-cataract/image/dense-cataract-treat.ts-1611574829943.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C0%2C1915%2C1078&w=1920&s=59e94f2fe6e3d0dcebe39c17f78d7111"})
Treat
Lens fragmentation of a dense cataract requires a lot more phaco energy to emulsify the hard nucleus. More energy increases the risk of damage to corneal endothelial cells, which, in turn, can cause post-operative complications.1,2
![]({"small":"https://images.zeiss.com/med/ref_international/products/essential-line-basic-diagnostics/slit-lamp-family/sl-800/images/variolight-cold-white-filter.ts-1569857330741.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=4%2C247%2C988%2C557&w=640&s=71a7e5bcd782fd2c09d5f7b2e22961d0","large":"https://images.zeiss.com/med/ref_international/products/essential-line-basic-diagnostics/slit-lamp-family/sl-800/images/variolight-cold-white-filter.ts-1569857330741.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=4%2C247%2C988%2C557&w=1280&s=a439178912745c35730e160df28fa8aa","medium":"https://images.zeiss.com/med/ref_international/products/essential-line-basic-diagnostics/slit-lamp-family/sl-800/images/variolight-cold-white-filter.ts-1569857330741.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=4%2C247%2C988%2C557&w=832&s=ccd869b7eb3b7a683f4d295bc7fb1e95","full":"https://images.zeiss.com/med/ref_international/products/essential-line-basic-diagnostics/slit-lamp-family/sl-800/images/variolight-cold-white-filter.ts-1569857330741.jpg?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=4%2C247%2C988%2C557&w=1920&s=4ba9f47e0d913819f8df36a4ea86274e"})
Check
After the removal of a dense cataract, patients expect to quickly and permanently regain perfect vision. However, post-operative complications like inflammation and edema can be more common after hard cataract surgery, and, longer term, issues like dislocated IOLs or dysphotopsias may occur.5,6
ZEISS Solution
Efficient cataract workflow even in case of dense cataracts
ZEISS offers reliable technologies and services to optimize cataract procedures - even when a supposedly routine case turns into a challenge. Trust ZEISS solutions for managing dense cataracts to save time and money without compromising your standards or risking an excellent patient outcome.
![]({"small":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/premium-cataract/image/iolmaster-700-1x1-transparent.ts-1598455516417.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C217%2C1496%2C1124&w=640&s=35752410500a8946e192d5bab876be2a","large":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/premium-cataract/image/iolmaster-700-1x1-transparent.ts-1598455516417.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C217%2C1496%2C1124&w=1280&s=42c9dddcfa06191644de0be51747c73d","medium":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/premium-cataract/image/iolmaster-700-1x1-transparent.ts-1598455516417.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C217%2C1496%2C1124&w=832&s=9c9c73c7a0ea44b34163018e12263ea9","full":"https://images.zeiss.com/med/ref_international/specialties/ophthalmology/premium-cataract/image/iolmaster-700-1x1-transparent.ts-1598455516417.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=0%2C217%2C1496%2C1124&w=1920&s=00fa28c2c0c534237b346a18375e1996"}){kind=spacer}
ZEISS IOLMaster 700
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ZEISS VERACITY surgical
See how OCT technologies can help manage dense cataracts.
Using the ZEISS IOLMaster 700 with up to 99% cataract penetration rate7 and identifying retinal pathologies with the ZEISS CIRRUS 6000, the performance OCT, for workflow efficiency in the cataract practice.
ZEISS VERACITY Surgical
VERACITY Surgical™ from ZEISS integrates electronic health record data and diagnostic pre-op measurements to enable a seamless, efficient surgical planning workflow solution.
![]({"small":"https://images.zeiss.com/med/ref_international/products/phacoemulsificationvitrectomysystems/miloop/images/miloop-product-pic-generation-2.ts-1598544804473.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=467%2C0%2C1498%2C1125&w=640&s=bad23328eafa52402ed25308292fd1ec","large":"https://images.zeiss.com/med/ref_international/products/phacoemulsificationvitrectomysystems/miloop/images/miloop-product-pic-generation-2.ts-1598544804473.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=467%2C0%2C1498%2C1125&w=1280&s=fd0daee57f8bd64c8d395e40b7235ce8","medium":"https://images.zeiss.com/med/ref_international/products/phacoemulsificationvitrectomysystems/miloop/images/miloop-product-pic-generation-2.ts-1598544804473.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=467%2C0%2C1498%2C1125&w=832&s=8520e58ae5eb855ae70f7911c3d449f8","full":"https://images.zeiss.com/med/ref_international/products/phacoemulsificationvitrectomysystems/miloop/images/miloop-product-pic-generation-2.ts-1598544804473.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&rect=467%2C0%2C1498%2C1125&w=1920&s=d9c039825da3c19eeda0c9f2c06d5406"})
ZEISS miLOOP
![]({"small":"https://images.zeiss.com/med/ref_international/products/data-management-software/retinaworkplace/image/zeiss_ct_lucia_602_v004_blau.ts-1613379196049.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&w=640&s=efb1dcd4236ae860e94bbbb8984a4e75","large":"https://images.zeiss.com/med/ref_international/products/data-management-software/retinaworkplace/image/zeiss_ct_lucia_602_v004_blau.ts-1613379196049.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&w=1280&s=05d8943e9347eefd62abcd989f8c36fd","medium":"https://images.zeiss.com/med/ref_international/products/data-management-software/retinaworkplace/image/zeiss_ct_lucia_602_v004_blau.ts-1613379196049.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&w=832&s=2ce892cffaf8ab4efe2b77d584ce9c67","full":"https://images.zeiss.com/med/ref_international/products/data-management-software/retinaworkplace/image/zeiss_ct_lucia_602_v004_blau.ts-1613379196049.png?auto=compress%2Cformat&fm=png&ixlib=java-1.1.11&w=1920&s=e76533348606d575f2a827c1e9907f9d"})
ZEISS CT LUCIA 602
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ZEISS OPMI LUMERA 700
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ZEISS ARTEVO 800
Explore ZEISS technologies for dissecting the dense nucleus while protecting endothelial cells.
Using the ZEISS miLOOP for zero-energy lens fragmentation and ZEISS Z-CELCOAT* and Z-HYALCOAT* for protecting delicate ocular tissues - reliable support for handling dense cataracts.
Optimal visualization is also vital in dense cataract cases. ZEISS OPMI LUMERA 700 and ZEISS ARTEVO 800 both deliver the highest levels of visualization needed in these cases.
ZEISS CT LUCIA 602
3-piece hydrophobic IOL with ultra-high purity acrylic polymer with no reported glistening.
* ZEISS Z-CELCOAT and Z-HYALCOAT are not available in the US.
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ZEISS SL 800
ZEISS VERACITY surgical
Trust ZEISS Premium optical quality for consistent post-op diagnostics and stable refractive results:
ZEISS SL 800
The SL 800 slit lamp from ZEISS equips you with an all-around setup for the observation of anterior and posterior segment.
ZEISS VERACITY Surgical
Post-op automated analytics and a-constant optimization.
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- 1 M. Colvard, Phacoemulsification of the rock hard cataract, Eyeworld 2012, https://www.eyeworld.org/article-phacoemulsification-of-the-rock-hard.
- 2 U. Devgan, Dense brunescent cataracts present surgical challenges, Ocular Surgery News 2011, https://www.healio.com/news/ophthalmology/20120331/dense-brunescent-cataracts-present-surgical-challenges.
- 3 S.Garg, Surgeons meet challenges of removing rock-hard cataracts, Ocular Surgery News 2018, https://www.healio.com/news/ophthalmology/20181010/surgeons-meet-challenges-of-removing-rockhard-cataracts.
- 4 A.Brissette, OCT Is Indispensable for Pre-op Cataract Evaluation, Opthalmology Management 2019, https://www.ophthalmologymanagement.com/newsletters/insights-into-integrated-diagnostic-imaging/may-2019.
- 5 http://corporate.ewreplay.org/?v=6122663037001.
- 6 R. J. Olson, MD, Salt Lake City, Review of Ophtalmology, PUBLISHED15 JANUARY 2005 Demystifying Dysphotopsia.
- 7 R. Varsits, N. Hirnschall, B. Doeller, O. Findl; Increasing the number of successful axial eye length measurements using swept-source optical coherence tomography technology compared to conventional optical biometry; presented at ESCSR 2016.