CALLISTO Eye Quick Reference Guide Sept 2019

Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Introduction - Algorithm

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ZEISS CALLISTO eye® aligns the microscope image (colored picture) according to the reference picture (black & white, captured by the ZEISS IOLMaster ®) regarding the position of the scleral blood vessels. Fine adjustment has to be done by the user after successful matching to ensure reliable assistant functions.

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The good quality of the reference picture is the starting point of a successful toric IOL alignment. If the reference picture is not in good quality, repeat the ZEISS IOLMaster measurement!

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Capture the IOLMaster reference picture

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Use the side covers on the ZEISS IOLMaster headrest or put a black rag over the patients head to avoid disturbing light reflections on the sclera

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Advise the patient to blink once before starting the measurement to ensure a proper tearfilm  keratometric values of anterior corneal surface is measured again while capturing the reference picture. Use artificial drops if patient has tearfilm of bad quality

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Eyes opened widely – if patient cannot open the eyes widely by his own (e.g. due to Ptosis), lift the upper lid by using a Q-tip. Be carefull to not squeeze on the cornea while lifting the upper lid, otherwise keratometric values will be falsified

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Lids too close Defocussed Nasally disturbing light

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Lids too close Defocussed Nasally disturbing light – scleral blood vessels not visible at all!

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Lids too close

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Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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Too dark

2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Capture the IOLMaster reference picture

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The green arrows, the traffic light and the color code help you to find the right measurement position for focus & centration

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Check the image quality directly after the ZEISS IOLMaster measurement: focus, centration, sharpness & the amount of scleral blood vessels. Repeat the measurement if needed!

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defocussed

The good quality of the reference picture ensures your success of the matching on ZEISS CALLISTO eye! decentered

lids too close

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Microscope requirements

a.

White balance test was performed successfully on a piece of white paper

b.

Microscope head is not tilted above the patients eye – 2 small black lines are coincident, if not adjust over the big black knob*

c.

For an homogenous red reflex the microscope illumination should be set up: 100% coaxial illumination (SCI) : 30 – 50% full field illumination*

d.

*b)

*c)

No light sources switched on next to the microscope head, which can produce dusturbing light reflections on the patients eye Adjust directly at the microscope, or:

e.

Light filters are deactivated (e.g. yellow filter) SCI 100% FF 30-50%

adjust under Lumera options at CALLISTO Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Import Patient

Import Patient 1. Import patient data* − FORUM (LAN) − IOLMaster (USB) 2. Or set up the patient directly on CALLISTO eye screen

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*IOLMaster report of ZEISS IOLMaster 500 or ZEISS IOLMaster 700 including the reference picture

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Check availability of the reference picture

Attention – in case of poor image quality, matching can fail!*

Check again the quality of the reference picture under documents of the activated patient: -

Focus on scleral blood vessels Eye open, lids not covering No disturbing light reflections on the sclera *Check for example the valid CALLISTO eye user manual or the quick guide of ZEISS IOLMaster 500: QUG IOLMaster 500 option reference image.pdf

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Preparation Phase

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Select the patient

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Prepare the treatment (2) • Treatment position • Apply ZEISS IOLMaster data • Incisions & paracentesis: size & position • Rhexis size • Z ALIGN: axis for toric IOL alignment • LRIs: size & position

3.

Start the treatment (3) for selected patient under patient administration to enable video record function & markerbased or markerless referencing

3.

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Parfocality

Parfocality: Live video & camera image are in the same focus

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

1.

Microscope head is in default position

2.

Move the microscope head above the patients eye until it is sharp on the video screen

3.

Maximum magnification

4.

Adjust the focus on the cornea on the video screen

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Adjust the microscope − Pupil distance − Eye cups (turn out if not wearing spectacles) − Diopters (use far correction if needed)

6.

Reduce the magnification and center the eye

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Requirements before the referencing

Additionally pay attention to: •

No surgical instruments around the eye

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Incisions are not performed

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Limbus is completely visible on the video screen*

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Sclera is 360° visible around the limbus without occlusion of speculum, lids or lashes

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No accumulation of liquids in the eye

Attention Referencing can fail in case of Chemosis or bleeding!

*Video image section visible in the ocular

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Set the reference axis - markerless

Set the Reference Axis Markerless option:

1.

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Click on „Reference“ to perform the referencing

2.

If reference image is available the option “IOLMaster Reference” is pre selected

3.

Option “Markers” will be chosen if no reference image is available

4.

Adjust “image quality for Reference” by using the guideline which is also displayed in the eye piece of the microscope if DIS (5) is activated

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4. 5.

Attention: Referencing can fail if the scleral blood vessels are not clearly visible to the camera! Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Alignment of the microscope image

Verify alignment of microscope image (colored) with the reference image (black & white) and correct the position by using the arrow buttons if needed. Use the overlay, side by side or grid option to check the position of the blood vessels.

If surgeon confirms the alignment of the microscope image, press “OK“ under confirmation. A good alignment of both pictures is mandatory to ensure reliable assistant functions!

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Alignment of the microscope image

Check position of the blood vessels

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After pressing the button for the matching, the software is pre aligning the microscope image to the reference picture by rotation until the scleral blood vessels are on the same position The fine adjustment has to be done by the user by using the arrow buttons

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

The two image modes “side_by_side” and “overlay” help for the alignment

2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Alignment of the microscope image

1.

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Use the unrolled pictures (1+2) of the scleral blood vessels around the limbus under the reference picture & the microscope image for easier fine adjustment of the matching

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Complete visibility of the scleral blood vessels in the green & the pink area is needed for stable data injection and reliable tracking during the surgery

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Good quality of the microscope image is also mandatory for stable data injection and reliable tracking  Right magnification  Scleral blood vessels focused  No liquid on the eye  No instruments in the picture

2.

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Adjust Limbus size

If needed you can adjust the limbus size. By pressing button 1. a new menu opens. To manually set an approximation for the size of the limbus circle, place three points on the limbus circle in the video image. Click on ok if surgeon confirms the new marking of the limbus.

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Attention: The manually set limbus circle is used to automatically find the best match with a circle pattern of the same size in the video image. The detected limbus circle found will then be used to determine the reference axis for tracking.

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

2019-09-03

15

Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Matching the reference image - markerbased

Markerbased option: 1.

Only 2 blue markings are visible on the sclera

2.

If not already preselected mark treatment position of the surgeon and choose option markers

3.

Specify the references axis if image quality for reference is good

Attention – Manual marking of the reference axis works on CALLISTO eye only if the eye of the patient was previously marked with blue ink! Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Matching the reference image - markerbased

Markerbased option

2 1 4

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Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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4.

Reference axis will be set automatically

5.

If needed realign the position of the reference axis with the arrow buttons (1)

6.

If necessary adjust the limbus size (2)

7.

If surgeon confirms the position of the reference axis press ok (3)

8.

Change to manual mode in case reference axis will not be set automatically (4)

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Matching the reference image - markerbased

Markerbased option 9. 1

In case you changed to manual mode a further menu opens

10. Set the markers by tapping two reference points on the live image on the position of the blue ink marks on the cornea

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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11. If necessary you can also adjust limbus size (1) or adjust the position of the reference axis by using the arrow buttons (2)

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12. If surgeon confirms press OK (3)

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Microscope requirements

The reference axis is set according to the alignment. The overlays for incisions / LRI, Rhexis and Z ALIGN are now visible, if the data injection (DIS) is activated (1).

1

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

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2019-09-03

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Quick Guide - ZEISS CALLISTO eye 3.6 matching the reference image Do’s & Don’ts

Do’s

Don’ts Reference picture: • Eye lids too narrow • Scleral blood vessels defocused • Nasal disturbing light reflections

Reference picture: • Eye wide open • Homogeneous illumination • Focus on scleral blood vessels

Live image: 1) Focus on eye lids – scleral blood vessels blurred & limbus decentered

Live image: • Focus on scleral blood vessels • Limbus centered & ⅔ of screen height

2) Magnification too high & limbus decentered

3) Lids & eye lashes covering the scleral blood vessels, too much liquid in the eye

Carl Zeiss AG, Sylvia Andrea Schwarz, Learning Management MED

EN_39_150_0025I

2019-09-03

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