EyeWorld Asia-Pacific September 2018 Issue

54 EWAP DEVICES September 2018 by Rich Daly EyeWorld Contributing Writer Reports of early use of Zepto Surgeons share pearls and surgical results for the capsulotomy device approved for the U.S. market in 2017 T he latest device ap- proved to create capsulotomies has provided cataract sur- geons with a helpful option and some unexpected benefits. The Zepto capsulotomy system (Mynosys Cellular Devices, Fre- mont, California) uses a handpiece attached to a laptop-sized console to create a “phase transition” of water molecules trapped between the device and the capsule to create capsulotomies, said David Sretavan, MD, cofounder of Mynosys Cellular Devices. “What’s unique is that the tis- sue cutting action is delivered by a ring, so the capsulotomy happens 360 degrees at the same time,” Dr. Sretavan said. “Surgeons using Zepto have identified its unique capsulotomy action as beneficial in high pressure cataract situa- tions where it relieves pressure and completes the entire capsulotomy at the same instant.” The device involves three steps: creating suction so the cut- ting element is opposed tightly against the capsule surface; direct- ing the energy to the capsule ring; and reversing suction at the end of the procedure to float the Zepto tip off the capsule. The U.S. Food and Drug Ad- ministration granted 510(k) clear- ance for the Zepto in June 2017. Elizabeth Yeu, MD, assistant professor, Eastern Virginia Medical School, Norfolk, Virginia, has used the device for 3 months and found getting comfortable with it was relatively easy. “I love having the ability to create a standardized, well- centered capsulotomy in the OR and saving the time that it takes me to create the same step in the laser room with femtosecond laser assistance,” Dr. Yeu said. Dr. Yeu sees its ability to auto- mate the capsulotomy as a boost to refractive outcomes. David F. Chang, MD, clini- cal professor, University of Cali- fornia, San Francisco, has used the Zepto device since the 2016 FDA clinical trial and said the learn- ing curve to master its nuances is about 10 cases. Dr. Chang agreed that effi- ciency is one major advantage of the device. Surgeons merely use the disposable Zepto tip in lieu of capsule forceps in the normal surgical sequence. “This means that you can employ Zepto after iris retractors have been inserted for a small IFIS pupil, for example,” Dr. Chang said. Kevin Waltz, MD, president, Ophthalmic Research Consultants, Indianapolis, has used the device since 2016 and found it has pro- vided more reliable capsulotomies than manual techniques. “The advantage of that is there’s great centration of the op- tics with the capsulotomy so you don’t get lens tilt, decentration, or a lot of things that could be uncomfortable if you don’t have a perfect capsulotomy,” Dr. Waltz said. Manual capsulotomies are frequently too small, off center, or irregular, which can affect lens positioning. Dr. Waltz said the device has fit well within the clinical work- flow, with it taking the same or less time as other approaches. Another key component of the device is that it allows patients to interact with the surgeon during surgery by fixating on a surgical light, which allows the device and the capsulotomy on the visual axis. The Zepto capsulotomy system, including handpiece and control console