TABLE 6.1 Nomogram for Technolas PlanoScan | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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The Technolas 217z Platform
The Technolas 217z Platform
Robert W. Weisenthal
Parag A. Majmudar
For more information on the Technolas Zyoptix 217z platform:
Technolas Perfect Vision GmbH
Messerschmittstr. 1 + 3
80992 München, Germany
www.technolaspv.com
Technolas American Regional Office
3365 Tree Court Industrial Blvd
St Louis, Missouri, 63122
The Technolas 217z system is capable of conventional laser treatment with PlanoScan software as well as wavefront-guided treatment using the Zyoptix system. The laser treatment is delivered with flying spot technology utilizing a 1 or 2 mm beam at 100 Hz. The FDA-approved treatment ranges are listed in Table 6.1. The Technolas 217z laser has Advanced Control Eyetracking (ACE) and iris registration software. The iris registration software ensures that the correct patient and eye are treated. It checks for rotational misalignment between the diagnostic examination (sitting) and laser treatment (supine) and compensates for pupil center shifts between the dilated and undilated examinations. The ACE technology tracks in four dimensions (x, y, and z axis as well as cyclorotation). The active eye tracker consists of an infrared imaging camera system capturing the geometric center of the undilated pupil at a sampling rate of 240 Hz plus a scanning system to respond and compensate for any detected pupil movement within 2.4 ms. The x–y active tracking range is defined as a deviation of 1.5 mm from original fixation. Within this active range, the laser adjusts the excimer pulses to the intended location according to the pupil position. If, however, the eye moves outside this range, the laser will interrupt the treatment. To account for very fast eye movements (e.g., sudden loss of fixation), a dynamic tracking module recognizes the speed of eye movements by calculating positional changes of the center of the pupil between pictures captured by the eye tracker’s video camera system. If the eye speed exceeds a clinically significant value, the eye tracker software simply interrupts the pulsing until the eye stabilizes again. The surgeon defines the treatment center prior to each ablation according to pupil reference, maintaining full visual control throughout the entire treatment. Using the keypad, the surgeon can manually adjust the treatment center at any time; although this is usually unnecessary once the treatment has begun. The dynamic rotational eye tracking system actively tracks and adjusts for cyclorotation during the laser ablation at a sampling rate of 25 Hz within a 15-degree range. The tracker for the z-axis is passive, interrupting the laser treatment if movement during treatment exceeds 0.5 mm from the initial setting.
▪ PlanoScan for Conventional LASIK
The PlanoScan platform is approved for treatment of myopia ≤ -12.0 diopter (D) with ≤3.0 D of cylinder, and hyperopia ≤ +4.0 D and ≤2.0 D of cylinder. It is not FDA-approved for treatment of mixed astigmatism, but it can be treated off-label using a two-card approach. The PlanoScan treatment still offers significant flexibility in programming due to the customizable optical zone (OZ) ranging from 4.0 to 7.0 mm in 0.1 mm increments, although an OZ <5.0 mm is not recommended. The PlanoScan ablation profile also includes a blend zone that extends the diameter of treatment from an additional 2.0 to 3.0 mm. As such, a 6.0-mm optical zone provides a total ablation of 8.9 mm for spherical corrections, and even larger ablations for cylindrical corrections. For cylindrical corrections, the Technolas 217z maintains the minor axis of the ellipse and extends the major axis. This is in contrast to other systems, which decrease the minor axis, in order to create an elliptical ablation. For this reason, the incidence of subjective night vision symptoms with conventional treatment compares favorably with custom treatments using other excimer laser systems.
It is felt that employing a large optical zone optimizes the visual outcome as well as promoting long-term refractive stability. However, a large optical zone also increases the depth of tissue ablation, so caution must be exercised when performing LASIK in patients with large corrections or relatively thin corneas. The rule of thumb ablation depth for the PlanoScan treatment has been approximately 15 µm/D at a 6.0-mm optical zone, but ranges from 10 µm/D at a 4.5-mm optical zone to 25 µm/D at a 7.0-mm optical zone. However, there is now an advanced PlanoScan algorithm designed to conserve tissue while maintaining the sphero-cylindrical profile of the ablation. This is accomplished using a combination of 1- and 2-mm beam sizes during the laser treatment rather than a 2-mm flat top beam exclusively as in the original PlanoScan ablation. The variation in spot size reduces the blend zone and slightly reduces the central ablation depth. The difference in tissue ablation between the two algorithms can be found in Table 6.1.