Zeiss OPMI Lumera T User Manual

OPMI Lumera® T
with Integrated
Assistant's Microscope
Instructions for use
G-30-1682-en
Issue 4.0
2
Key to symbols
Different symbols used in this manual draw your attention to safety as­pects and useful tips. These symbols are explained in the following.
Warning!
The warning triangle indicates potential sources of danger which may constitute a risk of injury for the user or a health hazard.
Caution:
The square indicates situations which may lead to malfunction, defects, collision or damage of the system.
Note: The hand indicates hints on the use of the system or other tips for the user.
®
OPMI
, Lumera®, Superlux®, Invertertube® and HaMode® are regis-
tered trademarks of Carl Zeiss Surgical GmbH.
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Contents
Key to symbols 2
Functions at a glance 7
OPMI Lumera T with integrated assistant's microscope 8
OPMI Lumera T (option) 9
Light sources 10
S88 floor stand 12
S8 ceiling mount 14
S81 ceiling mount 16
Safety 19
Notes on installation and use 21
When using a wide-angle observation system (e.g. BIOM 3) 25
Phototoxic retinal injury in eye surgery 25
Safety devices of the suspension systems 32
Warning labels and notes 44
Description 51
Lumera T surgical microscope 54
Intended use 54
Description of components 54
Illumination system 60
Controls, displays, connections 64
Binocular tubes and eyepieces 72
Light sources 78
Halogen light source (option) 80
Superlux Eye light source 84
Superlux Eye with integrated halogen light source (option) 92
Identical components of the suspension systems 98
Suspension arm 98
Display field with control keys 100
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S88 floor stand 102
Intended use 102
Description of components 103
–Design 104
Stand base with column 106
Connection panel 108
Instrument tray (option) 110
Video monitor (option) 112
S8 ceiling mount 120
Intended use 120
Description of components 121
–Design 122
Power switch with connector (option) 124
S81 ceiling mount 126
Intended use 126
Description of components 127
–Design 128
Power switch, connector and socket (option) 130
OPMI Lumera T with integrated assistant's microscope on S88 floor stand 132
Intended use 132
–Design 132
OPMI Lumera T with integrated assistant's microscope on S8 ceiling mount 134
Intended use 134
–Design 134
OPMI Lumera T with integrated assistant's microscope on S81 ceiling mount 136
Intended use 136
–Design 136
Foot control panel 138
Intended use 138
–Design 138
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Preparations 143
Attaching the equipment 144
Mounting the surgical microscope 144
Mounting the tube, the eyepieces and the objective lens 148
Changing the microscope accessories 152
Connections 154
Connecting the surgical microscope 154
Connecting the light guide 154
Strain relief device on S88 floor stand 158
Connecting the S88 floor stand 160
Relocating the system 162
Adjusting the supension system 164
Adjusting the balance setting of the suspension arm 164
Adjusting the limit of downward movement 166
Positioning the S8 ceiling mount 168
Settings on the control and display panel 170
Setting up the suspension system 170
Adjusting the surgical microscope 171
Optimizing the red reflex 172
Adjusting the tilt angle 174
Preparing the system for sterile use 176
Operation 179
Checklist 180
When using a wide-angle observation system (e.g. BIOM 3) 183
Positioning the S88 floor stand 184
Using the display and key field 186
General functions 186
Operating the OPMI® on the suspension system 190
Procedure 203
What to do in the event of malfunctions 205
What to do in an emergency 206
Lamp failure of the halogen light source 206
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Lamp failure in the Superlux Eye light source 208
Failure of lamp control 212
Failure of the focusing function 212
Failure of magnetic brakes 214
Failure of the X-Y coupling 214
Failure of the zoom function 215
Causes of malfunctions and remedies 216
Malfunctions in the surgical microscope 216
Malfunctions in the surgical microscope with integrated assistant's microscope 218
Malfunctions in the S8, S81 or S88 suspension system 219
Malfunctions in the video monitor 221
Malfunctions in the halogen light source 223
Malfunctions in Superlux Eye light source 224
Care and maintenance 227
Care of the unit 228
Sterilization 229
Disinfecting the control keys 230
Changing the halogen lamp 232
Changing the Superlux Eye xenon lamp module 234
Balancing the monitor arm 236
System data 239
Technical data 240
Magnifications / Fields of view 256
Ordering data 257
Spare parts 259
Disposal 260
Ambient requirements 261
CE conformity 261
Changes to the system 261
Index 263
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Functions at a glance 7
Functions at a glance
OPMI Lumera T with integrated assistant's microscope 8
OPMI Lumera T (option) 9
Light sources 10
S88 floor stand 12
S8 ceiling mount 14
S81 ceiling mount 16
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8 Functions at a glance
1
2
3
4
5
6
910 127141311
5
7
34 15 16 178
OPMI Lumera T with integrated assistant's microscope
1 Resetting X-Y coupling and focus to their initial positions page 64 2 Adjusting the interpupillary distance page 72 3 Adjusting the eyecups page 76 4 Setting your prescription page 76 5 Unlocking the magnetic brakes page 66 6 Display of the zoom system's magnification factor page 66 7 Changing the magnification of assistant's microscope page 70 8 Setting the inverter function page 70 9 Focusing the assistant's microscope page 70 10 Tilting the surgical microscope page 174 11 Arrows indicating the focusing range page 64 12 Locking screw for assistant's microscope (vertical) page 70 13 Zoom adjustment (manual emergency operation) page 215 14 Adjusting knob for different types of illumination page 68 15 Connecting the light guide page 154 16 Locking screw for assistant's microscope (horizontal) page 174 17 Setting the depth of field (DeepView) page 68
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Functions at a glance 9
1
2
3
4
5
6
8
10
7
1211
9
5
2
OPMI Lumera T (option)
1 Resetting X-Y coupling and focus to their initial positions page 64 2 Tilting the surgical microscope page 174 3 Adjusting the eyecups page 76 4 Setting your prescription page 76 5 Unlocking the magnetic brakes page 66 6 Display of the zoom system's magnification factor page 66 7 Setting the depth of field (DeepView) page 68 8 Setting the illumination page 62 9 Arrows indicating the focusing range page 64 10 Adjusting the interpupillary distance page 72 11 Zoom adjustment (manual emergency operation) page 215 12 Connecting the light guide page 154
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10 Functions at a glance
1243
56 8
7
9
Light sources
Halogen light source
1 - Closed flap: main lamp is on
- Open flap: backup lamp is on 2 Selecting a filter page 80 3 Opening the lamp module page 80 4 Manual activation of backup lamp page 80
Superlux Eye light source 5 Selecting a filter page 84 6 Resetting the counter page 88 7 Opening the lamp module page 84 8 Manual activation of backup lamp page 84 9 Red segment is lit - backup lamp is in use page 84
page 80
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Functions at a glance 11
2456 78 913
Superlux Eye light source with
integrated halogen light source (option) 1 Selecting the filter for Superlux Eye light source page 93 2 Switching manually to the backup lamp of
page 93
Superlux Eye light source 3 Resetting the counter page 38 4 Opening the Superlux Eye lamp module page 80 5 Additional integrated halogen light source:
page 94
- Closed flap: main lamp is on
- Open flap: backup lamp is on
6 Selecting the filter for additional integrated halogen
page 94
light source 7 Opening the lamp module of integrated halogen
page 94
light source 8 Manual activation of the halogen light source's
page 94
backup lamp 9 Superlux Eye light source:
page 94
red segment is lit - backup lamp is in use
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12 Functions at a glance
S88 floor stand
1 Control unit page 186 2 Light source page 78 3 Unlocking the magnetic brakes of the suspension
system 4 Limiting the suspension arm's downward movement page 166 5 Removing/mounting the coupling for the
surgical microscope 6 Balancing the suspension arm page 164 7 Locking the stand in position page 106 8 Locking the suspension arm in its horizontal position page 98 9 Connecting the foot control panel,
connecting the remote control connector 10 Rated voltage display page 108 11 Connector panel page 108 12 Switching on the suspension system page 108
page 98
page 98
page 108
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Functions at a glance 13
12 43
56
7 4 8910,11,12
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14 Functions at a glance
S8 ceiling mount
1 Locking the suspension arm in its horizontal position page 98 2 Unlocking the magnetic brakes of the suspension
system 3 Balancing the suspension arm page 164 4 Light source page 78 5 Control unit (rotatable through 180° or 70°) page 186 6 Connecting the foot control panel,
connecting the remote control connector 7 Switching on the suspension system page 124 8 Releasing - moving - locking the lift arm page 122 9 Removing/mounting the coupling for the
surgical microscope 10 Limiting the suspension arm's downward movement page 166
page 98
page 124
page 98
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Functions at a glance 15
102798
1
5623 4
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16 Functions at a glance
S81 ceiling mount
1 Locking the suspension arm in its horizontal position page 98 2 Unlocking the magnetic brakes of the suspension
system 3 Balancing the suspension arm page 164 4 Light source page 78 5 Control unit (rotatable through 180° or 70°) page 186 6 Connecting the foot control panel if the suspension
system is installed on a ceiling track mount (option) 7 Connecting the remote control connector page 130 8 Connecting the foot control panel page 130 9 Switching on the suspension system page 130 10 Removing/mounting the coupling for the
surgical microscope 11 Limiting the suspension arm's downward movement page 166
page 98
page 130
page 98
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Functions at a glance 17
10 112
9
456123 87
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18 Functions at a glance
G-30-1682-en OPMI® Lumera® T Issue 4.0
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Safety
Safety 19
Notes on installation and use 21
When using a wide-angle observation system (e.g. BIOM 3) 25
Phototoxic retinal injury in eye surgery 25
Safety devices of the suspension systems 32
Warning labels and notes 44
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20 Safety
The device described in this manual has been designed and tested in ac­cordance with Carl Zeiss safety standards as well as German and inter­national standards. This guarantees a high degree of instrument safety.
The system described in this user manual has been designed in compli­ance with the requirements of:
–EN –IEC –UL –CSA
In accordance with Directive 93/42/EEC for medical devices, the com­plete quality management system of the company Carl Zeiss Surgical GmbH, 73446 Oberkochen, Germany, has been certified by DQS Deut­sche Gesellschaft zur Zertifizierung von Managementsystemen GmbH, a notified body, under registration number 250758 MP23.
As per Directive 93/42/EEC, the unit is a Class I instrument.
For USA: FDA classification Class I.
We would like to provide you with information about safety aspects which must be observed when handling this device. This chapter contains a summary of the most important information concerning matters relevant to instrument safety.
Important safety information has been incorporated in this manual and is marked with a warning triangle accordingly. Please give this information your special attention.
The correct use of the system is absolutely vital for safe operation. Please make yourself totally familiar with the contents of this manual prior to start­up of the instrument. Please also observe the user manuals of any addi­tional equipment. Further information is available from our service depart­ment or from authorized representatives.
Please observe all applicable accident prevention regulations.
The instrument must be connected to a special emergency backup
line supply in accordance with the regulations or directives which ap­ply in your country.
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Safety 21
Notes on installation and use
Safe working order
Do not operate the equipment contained in the delivery package in
explosion-risk areas,
the presence of inflammable anesthetics or volatile solvents such
as alcohol, benzine or similar chemicals.
Do not station or use the instrument in damp rooms. Do not expose the instrument to water splashes, dripping water or sprayed water.
Switch off the unit at the power switch if you notice any smoke, sparks or unusual noise. Do not use the unit until it has been repaired by our service team.
Do not place any fluid-filled containers on top of the instrument. Make sure that no fluids can seep into the instrument.
Do not force cable connections. If the male and female parts do not readily connect, make sure that they are appropriate for one another. If any of the connectors are damaged, have our service representative repair them.
Potential equalization: If requested, the instrument can be incorpora­ted into potential equalization measures.
Do not use a mobile phone in the vicinity of the equipment because the radio interference can cause the equipment to malfunction. The ef­fects of radio interference on medical equipment depend on a number of various factors and are therefore entirely unforeseeable.
Modifications and repairs on these instruments or instruments used with them may only be performed by our service representative or by other authorized persons.
The manufacturer will not accept any liability for damage caused by unauthorized persons tampering with the instrument; this will also for­feit any rights to claim under warranty.
Over longer distances (e.g. removal, return for repair, etc), the instru­ment may only be transported in the original packaging or in special return packaging. Please contact your dealer or the Carl Zeiss service team.
Use this instrument only for the applications described.
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22 Safety
Only use the instrument with the accessories supplied. Should you wish to use other accessory equipment, make sure that Carl Zeiss or the equipment manufacturer has certified that its use will not impair the safety of instrument.
When mounting accessory equipment, please make sure that the ad­missible total weight of the surgical microscope is not exceeded. (See label or chapter "Technical data").
Only personnel who have undergone training and instruction are al­lowed to use this instrument. It is the responsibility of the customer or institution operating the equipment to train and instruct all staff using the equipment.
Keep the user's manuals where they are easily accessible at all times for the persons operating the instrument.
Never look at the sun through the binocular tube, the objective lens or an eyepiece.
Do not pull at the light guide cable, at the power cord or at other cable connections.
This system is a high-grade technological product. To ensure optimum performance and safe working order, we recommend having it checked by our service representative as part of regular scheduled maintenance. If a failure occurs which you cannot correct with the aid of the chapter "What to do in the event of malfunctions“, attach a sign to the system stating it is out of order and contact our service representative.
Observe the labels showing the symbol "Risk of crushing“!
Notes on EMC (electromagnetic compatibility)
The system meets the EMC requirements of IEC 60601-1-2. During use of the system, the precautionary measures concerning EMC listed below must be observed.
Only use accessories that have been approved by Carl Zeiss for this system.
Do not use any portable or mobile high frequency communication devices in the vicinity of the system, as this may lead to an impairment of its func­tion.
The system complies with the limits for a Class A device concerning radio frequency emission. However, the possibility of interference to high fre­quency receiving devices (e.g. TV sets or radios) being used in the sur­roundings cannot be ruled out. If interference of this type occurs, please inform your Carl Zeiss Service.
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Safety 23
Requirements for operation
For ceiling mounts only: Our service staff or a qualified person ap­pointed by us will install the system on ceiling anchors which have been properly mounted by the construction engineers responsible. These ceiling anchors must comply with the specifications contained in our planning manual.
Our service representative or an expert authorized by us will install the system. Please ensure that the following requirements are met for fur­ther operation:
All mechanical connections (details in the user's manual) which are
relevant to safety are properly connected and screw connections tight­ened.
All cables and plugs are in good working condition.
The voltage setting on the instrument conforms to the rated voltage of
the line supply on site.
The instrument is plugged into a power outlet which has a properly
connected protective ground contact.
The power cord being used is the one designed for use with this in-
strument.
Before every use and after re-equipping the instrument
Make sure that all ”Requirements for operation” are fulfilled.
Go through the checklist.
Re-attach or close any covers, panels or caps which have been re­moved or opened.
Pay special attention to warning symbols on the instrument (triangular warning signs with exclamation marks), labels and any parts such as screws or surfaces painted red.
Do not cover any ventilation openings.
For every use of the instrument
General
Never operate the system unattended.
Excessive radiation exposure times may lead to retinal injury in the pa­tient's eye. Never leave a system unattended when the light source has been activated.
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24 Safety
Avoid looking directly into the light source, e.g. into the microscope ob­jective lens or a light guide.
When the illumination is on, the light guide must be connected at both ends. Otherwise there is a risk of fire or burn injuries.
Make sure that the instrument has been switched off before you change the xenon lamp module. When switched on, the ignition sys­tem generates high voltage.
Xenon lamps feature high luminance and a spectrum resembling that of natural daylight. Therefore, only special xenon lamps approved by Carl Zeiss must be used in ophthalmology.
Any kind of radiation has a detrimental effect on biological tissue.This also applies to the light illuminating the surgical field. Please therefore reduce the brightness and duration of illumination on the surgical field to the absolute minimum required.
Phototoxic effect of light beams. When operating on the eye, always use the yellow protection filter to ensure that the patient's eye is not exposed to unnecessary (blue) radiation (risk of retinal injury).
Adjust the illumination intensity as required for the type of illumination used and the radiation exposure time. You will find the values recom­mended by Carl Zeiss in the table "Maximum radiation exposure times" on page 29.
S88 floor stand
Using the locking pedal on the base, secure the stand in position. Make sure that the stand is stable and cannot roll away.
After every use of the instrument
Always use the main power switch of the instrument to turn it off.
The main power switch must always be turned off when the instrument is not in use.
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Safety 25
1
2
Risk of collision!
When using a wide-angle observation system (e.g. BIOM 3)
When using a wide-angle observation system (e.g. BIOM 3 from Oculus) which is usually installed between the surgical microscope and the pa­tient, make sure that the patient is neither put at risk nor injured by the mo­torized focusing system or the movement of the suspension system arm.
Only use accessories expressly certified by the manufacturer for combi­nation with the surgical microscopes described in this manual.
Warning!
With the wide-angle observation system swung out of position, always position the microscope body in such a way that index dot (1) of the microscope's focus is in the middle of triangle (2) of the marking.
Select a medium magnification (e.g. 1.0).
Lower the surgical microscope toward the surgical field until you see the patient's cornea sharply defined.
Turn the setting screw for limiting the downward movement clockwise as far as it will go and check without the patient that the suspension arm cannot be lowered any further.
It is vital that you read the user manual for the wide-angle observation system used (e.g. BIOM 3 from Oculus).
Phototoxic retinal injury in eye surgery
General
1)-5)
Several papers surgery have been published. A comprehensive review of these publica­tions reveals five aspects of particular concern:
Illumination characteristics (spectral composition)
Illumination intensity
dealing with the problem of phototoxicity in ophthalmic
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Angle of illumination
Focus of the light source
Exposure time to light
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26 Safety
In the following, comments on these aspects are given and a description of how Carl Zeiss, as a manufacturer, makes allowance for them in its systems.
Illumination characteristics (spectral composition)
Studies on the exposure of the eye to light of varying spectral composition date back to the early 1950s. These studies suggest that the potential hazard of phototoxic injury to the patient's retina can be reduced by blocking out the blue and ultraviolet light below a wavelength of 475 nm.
For protection of the retina, Carl Zeiss offers the blue barrier filter (retina protection filter) as a standard feature of the OPMI Lumera surgical micro­scopes. This reduces not only the exposure of the patient's eye to light, but also that of the surgeon's.
An important point to note here, however, is that the use of filters will in­evitably change the perceived color of the light. For this reason, the phy­sician may initially have to get used to the changed appearance of the an­atomical structures.
Illumination intensity
The majority of researchers suggest that the surgeon should use the lowest light intensity required at the patient's eye to guarantee good viewing during surgery.
Carl Zeiss has addressed this aspect by providing its systems with a de­vice for continuously varying the brightness of the light source. This per­mits the surgeon to optimally adapt the light intensity at the patient's eye to the conditions existing in each case.
Angle of illumination
1)-4)
A number of publications
suggest that the microscope should be
tilted to reduce the exposure of the macula to direct illumination.
Carl Zeiss ophthalmic surgical microscopes are therefore equipped with the following:
Tilting mechanism for the microscope body
Surrounding field illumination with brightness control
Red reflex illumination (stereo coaxial illumination)
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Safety 27
Focus of the light source
Studies show that injuries are likely to occur if the filament of the light source is imaged on the patient's retina. The peak intensity of a filament is considerably higher than that of an even and extended light source such as a light guide.
This is the reason why Carl Zeiss uses fiber optic illumination in its sur­gical microscope systems.
Exposure time to light
According to some publications, the phakic and aphakic eye should not be exposed to the light source longer than a few minutes. In all surgical cases, the retinal exposure time depends on the type and duration of the procedure and possible case complications. It is therefore recommended in ophthalmic surgery to keep the light intensity as low as possible, or to use a device which prevents the light from entering through the patient's pupil. It is also recommended to make sure that the patient's eye is not additionally exposed to the light of surrounding light sources. This problem has been solved by Carl Zeiss by the use of a retinal protection device that can be swung into the microscope's illumination beam path and a blue barrier filter (retina protection filter).
Brightness control
The brightness control scale of our systems has a linear structure with values ranging from 0.5 to 10. The stipulations of standard ISO/FDIS 15004-2:2006(E) result in maximum radiation exposure times for the dif­ferent illumination configurations as specified in the table "Maximum radi­ation exposure times".
The microscope light source - like any bright light source - may present a hazard to the patient's eye both in the form of immediately visible thermal damage to the retina as well as phototoxic chemical reactions which may lead to photoretinitis. The factors which play an important role in deter­mining the phototoxic risk are:
Lamp brightness.
Spectral distribution of the light (UV and blue are more dangerous
than longer wavelengths).
Duration of direct exposure.
Pupil size.
Clarity of ocular media (infants and young children, for example,
may be at a higher risk).
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28 Safety
Phakic status of the eye (aphakic and pseudo-aphakic eyes with-
Previous exposure to bright light such as retinal photography, es-
The following table is intended to provide the surgeon with a guideline in determining the potential hazard. The data has been calculated for a worst-case scenario of direct, uninterrupted exposure of an aphakic eye with an 8 mm dilated pupil. The calculations are based on the recom­mended occupational health daily exposure limits as defined in safety factor of 10 has been used in determining these limits.
During cataract procedures, factors such as lenticular material, instru­ments such as the phaco handpiece, and movement of the eye provide interruption of the exposure and would be expected to significantly lengthen the time before photoretinitis might be expected to occur.
A prospective study gery did not reveal any phototoxic retinal injuries for procedure times of up to 30 minutes if the calculated maximum recommended exposure time was 150 seconds. However, it was also found that at the same brightness setting, phototoxic retinal injury could be expected after approximately 100 min.
out UV and blue filtering IOLs are at a higher risk).
pecially within the last 24 hrs.
7)
of the effects of microscope illumination during sur-
6)
. A
The red reflex illumination (stereo coaxial illumination) of OPMI Lumera has been designed to provide a bright red reflex using only very small quantities of light at the center of the light spot. The peripheral field illumi­nation causes higher exposure of the retina, but usually not directly of the macula, depending on the position of the eye. For cataract procedures, we recommend adjusting the surrounding field illumination to be some­what darker than the central red reflex spot. Not only does this setting minimize phototoxic risk, but it also reduces glare from the patient's sclera.
Other recommendations for minimizing phototoxic risk are:
Always use the lowest possible brightness setting.
Use the blue barrier filter (retina protection filter) to block the blue spectrum of light. The blue barrier filter will increase the recommended exposure times by factor three.
When working on the exterior eye, use the retinal protection device to prevent light from entering the pupil, especially when the pupil is dilat­ed.
Turn off the microscope illumination system or cover the patient's eye during pauses in surgery.
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Safety 29
Maximum radiation exposure times
The use of the blue barrier filter (retina protection filter) increases the rec­ommended exposure time by a factor of 3 compared with the values spec­ified below.
Red reflex illumination (stereo coaxial illumination)
Scale display of Illumination
Max. exposure time in minutes
Halogen Xenon Xenon with
HaMode filter
2.5 50 8.2 28
5 21 4.2 16.5
7.5 13 2.9 10.3
10 9 2.2 8.5
Surrounding field illumination
Scale display of Illumination
Max. exposure time in minutes
Halogen Xenon Xenon with
HaMode filter
2.58.72.58.9
53.71.35.2
7.52.20.93.3
10 1.6 0.7 2.7
Note: The illumination system of the surgical microscope contains a UV blocking filter as a standard feature.
This helps the surgeon to reduce the risk of phototoxic retinal injury in the patient.
List of references
1)
H. Stiller, and B. Rassow, "Light hazards to the patient's retina from
ophthalmic instruments," Applied Optics-OT 30, 2187-2196 (1991).
2)
American Conference of Governmental Industrial Hygienists, "Docu­mentation of the Threshold Limit Values for physical agents. 7th Edition," (American Conference of Governmental Industrial Hygienists, Cincinnati,
2001).
3)
S. G. Khwarg, F. A. Linstone, S. A. Daniels, S. J. Isenberg, T. A. Hanscom, M. Geoghegan, and B. R. Straatsma, "Incidence, risk factors, and morphology in operating microscope light retinopathy," Am. J. Oph­thalmol. 103, 255-263 (1987).
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30 Safety
4)
G. Kleinmann, P. Hoffman, E. Schechtman, and A. Pollack, "Micro­scope-induced retinal phototoxicity in cataract surgery of short duration," Ophthalmology 109, 334-338 (2002).
5)
ISO/FDIS 15004-2:2006(E) Optical instruments -- Fundamental re­quirements and test methods -- Part 2: Light hazard protection
6)
David Sliney, Danielle Aron-Rosa, Francois DeLori, Franz Fankhauser, Robert Landry, Martin Mainster, John Marshall, Bernard Rassow, Bruce Stuck, Stephen Trokel, Teresa Motz West, and Michael Wolffe, Adjust­ment of guidelines for exposure of the eye to optical radiation from ocular instruments: statement from a task group of the International Commission on Non-Ionizing Radiation Protection (ICNIRP) APPLIED OPTICS Vol. 44, No. 11, p 2162 (10 April 2005)
7)
Byrnes, G.A., Antoszyk, A.N., Mazur, D.O., Kao, T.C., Miller, S.A., Photic maculopathy after extracapsular cataract surgery. A prospective study, 1992/05/01 Ophthalmology, VL - 99, IS - 5, SP - 731, EP - 737, PB - Elsevier
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