Dense cataract removal and efficient procedure time management

Clinical Challenge

Lens extraction and procedure time

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 postoperative complications. Extracting a dense nucleus is also associated with longer procedures, impacting practice efficiency in terms of time and costs.1,2,3

Lens fragmentation of a cataract using ZEISS miLOOP; image courtesy of Florian Kretz, MD, DEU
Clinical Solution

From gold-standard phacoemulsification to zero-energy lens fragmentation

With more than 50 years4 of clinical experience, phacoemulsification is seen as the gold standard for lens fragmentation and extraction. Yet, only 25% of cataract surgeons feel confident performing chopping.Thus, a new technique for full-thickness nuclear fragmentation has been developed that uses a disposable micro-interventional device without ultrasound. This zero-energy approach has been shown to achieve consistent full-thickness nucleus disassembly and significantly improved overall phaco efficiency in dense cataracts.6,7

The application of the right viscoelastic substance to the cornea also helps to protect the corneal endothelium during the emulsification process.8

Experiencing innovative technology for fragmenting rock-hard cataracts

Case discussion with David Chang, MD, Robert Osher, MD, and William Wiley, MD

ZEISS Solution

ZEISS technologies for fragmenting dense cataracts while protecting eye tissues.

Using the ZEISS miLOOP for zero-energy lens fragmentation and ZEISS Z-CELCOAT* and Z-HYALCOAT* for protecting sensitive 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.


The first digital ophthalmic microscope brings a new era in visualization for greater certainty in surgery. ZEISS optics and the expansive possibilities of digital imaging enable you to see even more with greater comfort thanks to DigitalOptics, AdVision and Cloud Connectivity.


The OPMI LUMERA 700 from ZEISS is ideally suited for every ophthalmic surgery discipline. Experience markerless IOL alignment and integrated intraoperative OCT imaging - all in one device.


The ZEISS miLOOP allows you to:

  • Reduce phaco energy by up to 53% for grade 3-4+ nuclear cataracts6
  • Lower the surgical irrigation fluid volume used per case by up to 30%6
  • Apply minimal stress to the capsule and zonules6
  • Reduce procedure and post-operative treatment time7


CT LUCIA 602 from ZEISS is a 3-piece hydrophobic IOL with ultra-high purity acrylic polymer with no repeated glistening.

ZEISS OVD Portfolio

ZEISS provides two different OVDs to coat the delicate ocular tissues giving you the freedom to choose between a moderate and a comprehensive solution.


Low-viscosity dispersive OVD (HPMC), providing protection of the endothelium through coated ocular tissues.


Medium-viscosity dispersive OVD, a safeguard during various surgical manoeuvres, providing a great space partition.

*ZEISS Z-CELCOAT and ZEISS Z-HYALCOAT are not available in the US.

Peer Insights

Clinical experiences with ZEISS technologies

Dense cataract workflow challenges


A dense cataract is, by its very nature, difficult to penetrate. This makes pre-operative cataract evaluation, including biometric measurement and screening for macular pathologies that may affect outcomes, a challenge.2,3,9


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.5,10

Webinar trilogy: Treating dense cataracts – when routine becomes a challenge

Dr. Don Pek, Dr. Ruth Lapid-Gortzak, Dr. Nino Hirnschall, Dr. Sartaj Grewal & Dr. Franco Spedale

March 2021

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  • 1 M. Colvard, Phacoemulsification of the rock hard cataract, Eyeworld 2012,
  • 2 U. Devgan, Dense brunescent cataracts present surgical challenges, Ocular Surgery News 2011,
  • 3 S.Garg, Surgeons meet challenges of removing rock-hard cataracts, Ocular Surgery News 2018,
  • 4
  • 5
  • 6 Ianchulev T et al. Microinterventional endocapsular nuclear disassembly: novel technique and results of first-in-human randomised controlled study. Br J Ophthalmol 2019;103:176–180.
  • 7 Claim of reduced procedure time comes from an internal evaluation: post-market evaluation survey performed in 2019, n=279; data on file.
  • 8
  • 9 A.Brissette, OCT Is Indispensable for Pre-op Cataract Evaluation, Opthalmology Management 2019,
  • 10 R. J. Olson, MD, Salt Lake City, Review of Ophtalmology, PUBLISHED15 JANUARY 2005 Demystifying Dysphotopsia.