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VISU 200
Surgical Microscope
Instructions for use
G30-1298-en
Issue 2.0
Printed on 09. 11. 2006
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G30-1298-en VISU 200 Surgical Microscope Issue 2.0
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Key to symbols
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 instrument.
Note:
The hand indicates hints on the use of the instrument or other tips for
the user.
OPMI
®
is a registered trademark of Carl Zeiss.
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Contents
Functions at a glance 5
Safety 7
Description 17
VISU 200 Surgical Microscope 18
Attaching the equipment 43
Operation 47
Preparations for use 48
Procedure 53
What to do in an emergency 55
Maintenance / Further information 57
Index 71
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Functions at a glance 5
Functions at a glance
VISU 200 Surgical Microscope 6
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6 Functions at a glance
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VISU 200 Surgical Microscope
1 Resetting the X-Y coupling, focus and zoom to their initial positions
2 Locking the front-to-back tilt of the surgical microscope
3 Adjusting the PD
4 Adjustable eyecup
5 Diopter setting
6 Display of magnification factor of zoom system
7 Adjusting the red reflex illumination (+ 2° and - 2°)
8 Releasing the magnetic clutches of the stand
9 Changing the magnification of the assistant's microscope
10 Focusing the assistant's microscope
11 Adjusting the 6° illumination
12 Focusing range markings
13 Locking the assistant's microscope vertically
14 Light stop knob
15 Light guide socket
16 Locking the assistant's microscope horizontally
1
2
3
4
5
6
7 9 10 5 4 11 12 9 13 14 15 16108 8
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Safety 7
Safety
Directives and standards 8
Notes on installation and use 9
When using a fundus imaging system (e.g. BIOM II) 12
Phototoxic retinal injury in eye surgery 12
Warning labels and notes 15
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8 Safety
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The instrument described in this manual has been developed and tested
in accordance with Carl Zeiss safety standards and with national and international regulations. A high degree of instrument safety is thus ensured.
We would like to inform you on the safety aspects involved in operating
the instrument. This chapter contains a summary of the most important
precautions to be observed.
Further safety notes are also contained in other parts of this user's
manual; they are marked with a warning triangle containing an exclamation mark as shown here. Please pay special attention to these safety
notes.
Safety is only ensured when this instrument is operated properly. Please
read through this manual carefully before turning the instrument on. Also
read through the user's manuals of the other equipment used with this instrument. You may obtain further information from our service organization or authorized representatives.
Directives and standards
The instrument described in this manual has been designed in compliance with the following standards:
–EN
–IEC
–UL
–CSA
In accordance with Directive 93/42/EEC, Annex II, Article 3, the qualitymanagement system of Carl Zeiss has been approved by TÜV Rheinland,
which is a notified body. The registration number is: 95 102 7601.
• The instrument must be connected to a special emergency backup
line supply in accordance with the regulations or directives which apply in your country.
• This is a class I instrument as defined by Directive 93/42 /EEC.
• Please observe all applicable accident prevention regulations.
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Safety 9
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.
• Immediately unplug any equipment that gives off smoke, sparks or
strange noises. Do not use the instrument until our service representative has repaired it.
• 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: The instrument can be incorporated into potential equalization measures. For this purpose, contact our service department.
• 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.
• Use this instrument only for the applications described.
• 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.
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10 Safety
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• 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 instrument is a high-grade technological product. To ensure optimum performance and safe working order of the instrument, its safety
must be checked once every 12 months. We recommend having this
check performed by our service representative as part of regular maintenance work.
If a failure occurs which you cannot correct using the trouble-shooting
table, attach a sign to the instrument stating it is out of order and contact our service representative.
Requirements for operation
Our service representative or a specialist authorized by us will install the
instrument. Please make sure that the following requirements for operation remain fulfilled in the future:
– 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.
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Safety 11
• 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.
For every use of the instrument
• Avoid looking directly into the light source, e.g. into the microscope objective lens or a light guide.
• 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.
• When operating on the eye, always use a GG 475 protection filter to
ensure that the patient's retina is not exposed to unnecessary (blue)
radiation (retinal injury).
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12 Safety
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When using a fundus imaging system (e.g. BIOM II)
When using a fundus imaging system (e.g. BIOM II from the company 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 stand arm.
Only use accessories expressly certified by the manufacturer for combination with the surgical microscope described in this manual.
Caution!
• With the fundus imaging 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 towards the surgical field until you see
the patient's cornea sharply defined.
• Turn the screw for limiting the downward movement clockwise as far
as it will go.
• It is vital that you read the user’s manual on the fundus imaging system (e.g. BIOM II from the company Oculus).
Phototoxic retinal injury in eye surgery
General
Several papers have been published dealing with the problems of phototoxicity during eye surgery. A comprehensive review of these publications
reveals five aspects of particular concern:
– Illumination characteristics (spectral composition)
– Intensity of illumination
– Angle of illumination
– Focus of the light source
– Exposure time to light
1
2
Risk of collision!
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Safety 13
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 instruments.
Illumination characteristics (spectral composition)
Studies on 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.
Carl Zeiss provides a GG 475 retina protection filter for surgical microscopes recommended for use in ophthalmic surgery. This reduces not
only the light exposure of the patient's eye, but also that of the surgeon's.
It should be noted in this context that the use of filters inevitably leads to
a change in the color of the light. The surgeon may therefore have to get
used to the changed appearance of anatomical structures.
Intensity of illumination
The majority of researchers suggest that the surgeon should use the
lowest light intensity necessary to guarantee good viewing during surgery.
Carl Zeiss has addressed this concern by providing 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. Carl Zeiss strongly discourages the use of xenon or
other high-intensity light sources in ophthalmology.
Angle of illumination
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
– Oblique illumination with brightness control
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 the peak intensity of an even and extended
light source such as a fiber guide.
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This is the reason why fiber optic illumination is used in surgical microscopes from Carl Zeiss.
Exposure time to light
According to some publications, the phakic or aphakic eye should not be
exposed to the light source longer than a few minutes. In every operation
the exposure of the retina to light is dependent on the type and duration
of surgery and on any complications which occur. 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. Also, the surrounding light sources should not cause additional strain to the patient's eye.
Carl Zeiss has provided an answer to this problem in the form of a swingin retinal protection device for insertion into the beam path of the surgical
microscope. This device ensures total eclipsing of the pupil, preventing
light from entering into the patient's eye. It can be swung out when a red
reflex is required.
In conclusion
Carl Zeiss recommends:
– Use of the GG 475 eye protection filter.
– Reduction of the illumination of the surgical area to the extent required
for the patient's safety and for microscopic visualization.
– Tilting of the microscope body as required.
– Insertion of the retinal protection device.
– Maximum reduction of the exposure of the patient's eye to light from
surrounding light sources.
These measures should help the surgeon to reduce the likelihood of phototoxic retinal injury.
Note:
The standard equipment of the VISU 150 Surgical Microscope includes a
UV-blocking filter.
The integration of this filter ensures that the illumination intensity in the
wavelength range from 305 nm to 400 nm lies below the value of
50 µW/cm
2
required in the future ANSI standard.
These measures should help the surgeon to reduce the risk of phototoxic
retinal injury.
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Safety 15
Warning labels and notes
Caution:
Observe all warning labels and notes!
If any label is missing on your instrument or has become illegible, please
contact us or one of our authorized representatives. We will supply the
missing labels.
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16 Safety
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Description 17
Description
VISU 200 Surgical Microscope 18
Intended use 18
Description of the modules 18
Illumination system 26
Controls, displays, connections 28
Hand grips (option) 36
Tube and eyepieces for main microscope 38
Tube and eyepieces for assistant's microscope 40
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VISU 200 Surgical Microscope
Intended use
The VISU 200 surgical microscope has been designed for surgical procedures in the field of ophthalmology, i.e. the microscope meets the special
requirements of this discipline.
Description of the modules
The VISU 200 surgical microscope comprises the following modules:
1 X-Y coupling
The X-Y coupling allows fine, motorized positioning of the surgical microscope in a horizontal plane. The range of travel is 40 mm x 40 mm.
The speed of travel can be set on the display field of the stand.
The X-Y coupling is provided with a recentering facility. When you
press the activator button,
– the X-Y coupling adopts its center position,
– the focusing system of the main microscope is reset to its initial po-
sition,
– the zoom system is set to a preselected magnification factor, if the
function XYZ-RES has been selected (only possible with S8 Floor
Stand).
You can also trigger the recentering function on the foot control panel.
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Description 19
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2 Support arm for the surgical microscope
The support arm contains a tilt device, allowing the viewing direction
of the surgical microscope to be adapted to the surgical field as required. Use the fine tilt knob to position the surgical microscope in a
range from + 15° to - 90° (+ 15° in the direction of the surgeon and 90° in the opposite direction). The 90° position is ideal for surgery on
seated patients or patients lying on their side.
3 Main microscope
The apochromatic optics of the main microscope provide superb optical quality. The microscope image displays optimum contrast and excellent detail recognition along with a large depth of field. The bright
microscope image is a particular benefit in vitreoretinal surgery. A
zoom system with a 1:6 ratio makes it possible to adapt the magnification of the overall system to the surgical requirements.
Two apochromatic objective lenses with the focal lengths of 175 mm
and 200 mm are available for different working distances.
A tiltable 180° binocular tube is provided for the main surgeon. The
large tilt range allows work with minimum fatigue.
The standard equipment includes eyepieces with a magnification
factor of 12.5 x (option: 10 x).
The illumination system has been designed for use in ophthalmology.
A light guide directs the light from the light source in the stand to the
surgical microscope.
6° illumination can be continuously faded in. This allows the illumination intensity in the surgical field to be set continuously, without
changing the color of the light. The illumination of the surgical field at
an angle of 6° produces an image with outstanding impression of
depth.
An additional illumination system produces an intensive red reflex,
even if the patient's eye is in an unfavorable position. The angle of illumination can be switched between + 2° and - 2°.
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Description 21
2
3
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To protect the patient's eye against photo-retinitis, a retinal protection device is provided. This device can be swung into the illumination beam
path, if no red reflex is required.
At the light source integrated in the stand, a GG 475 eye protection filter
can be swung into the illumination beam path. This filter markedly reduces
the exposure of the patient's and surgeon's eyes to radiation.
A video camera from our MediLive video camera line can be optionally
connected to the VISU 200 surgical microscope. The light loss for the surgeon is only 20% and cannot be perceived subjectively.
Caution!
– Avoid looking directly into the light source, e.g. into the microscope ob-
jective lens or into the light guide!
– When selecting the brightness level for the patient's eye, always take
care to keep the strain on the patient's eye to a minimum.
– If the red reflex is not necessary, move the retinal protection device
into the beam path. Only use the retro-illumination contrast stop, if the
surgical procedure requires a red reflex.
– When operating on the eye, always use a GG 475 eye protection filter
to ensure that the patient's retina is not exposed to unnecessary (blue)
radiation (retinal injury)!
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Description 23
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24 Description
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4 0° assistant's microscope
The assistant's microscope is an integral part of the VISU 200 surgical
microscope, i.e. it cannot be separated from the main microscope.
The assistant sees the same image as the main surgeon. The
system's excellent image quality is also available to the assistant.
The assistant's microscope has two working positions. They are located on the right and left of the main surgeon at an angle of 90° to the
main surgeon's viewing direction. No clickstop mechanism is provided, allowing the assistant to move the microscope by a certain
amount from the 90° position, if necessary.
To prevent the assistant's microscope from moving down to the side
of its own accord when the main microscope is being tilted, the assistant's microscope must be adjusted and locked in position using
screw (5) before surgery.
The assistant's microscope is equipped with a focusing system and a
5-step magnification changer. This enables the assistant to adjust his
microscope image independently of the main surgeon.
The binocular tube can be turned by ± 12° about the optical axis of the
assistant's microscope. In addition, the assistant's microscope can be
tilted by 15°. If the assistant finds the viewing angle too steep, an optical wedge (option) can be installed between the microscope body
and the binocular tube to permit horizontal viewing.
The standard equipment includes eyepieces with a magnification
factor of 10x, providing a low initial magnification. This provides the
benefit of a wide field of view and an improved overview of the surgical
field. The assistant sees the red reflex in both eyepieces.
5 Locking screw for assistant's microscope
After adjusting the assistant's microscope as required, secure it in position using this screw.
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Description 25
4
5
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Illumination system
6° illumination
You can continuously fade out the 6° illumination. This results in markedly
reduced reflection from the cornea, while providing nevertheless a highcontrast, informative microscope image.
For cataract surgery, we recommend opening the 6° illumination system
approx. 25%.
2° illumination
You can switch the illumination from +2° to -2°. This ensures good visibility of the red reflex even when the patient's eye is decentered.
1 6° illumination and 2° illumination
2 2° illumination with centered patient's eye
Here, the red reflex is clearly visible in both positions (+2° and -2°).
3 2° illumination with decentered patient's eye
The red reflex is no longer visible at +2°. After switching to -2°, the red
reflex is again clearly visible.
- 2° + 2°
+ 6°
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Description 27
1
2
3
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28 Description
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Controls, displays, connections
1 Instrument connector
2 Microscope pivot
3 X-Y coupling
4 Activator button
– recenters the X-Y coupling.
– resets the focus to its initial position in the focusing range.
– resets the zoom system to a predefined magnification factor, if the
XYZ-RES functions has been selected (possibe with S8 Floor
Stand only).
Note:
Press this button to start the recentering movement. To stop the
movement, press the button again.
You can also stop the recentering movement by briefly tipping on one
of the direction keys on the foot control panel.
5 Clip for cable and light guide
6 Support arm with tilt device
7 Knob for
adjusting the front-to-back tilt of the surgical microscope;
+ 15° in the direction from the surgeon,
- 90° in the opposite direction.
8 Indicator marks for focusing range
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Description 29
1
3
4
5
6
7
8
2
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9 Dust cover
10 Release buttons for the magnetic brakes of the stand
Only in connection with suspension systems with magnetric brakes.
A second button with the same function is located on the opposite side
in the knob for the additional red reflex illumination.
11 Maneuvering grip including release button. See (10).
12 Display of the magnification factor of the zoom system
13 Securing screw
– Button pressed magnetic brakes are released, the unit
can be moved as required.
– Button released magnetic brakes are locked, the unit
cannot be moved.
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Description 31
11 12 13
10
9
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14 Manual adjustment of zoom system
15 Knob for adjusting the red reflex illumination
The angle of illumination can be switched between + 2° and - 2°.
16 Release button for magnetic brakes
(A second button with the same function is located in maneuvering
grip (10).
17 Securing screw
for locking the assistant's tube within its 12° range of movement.
18 Binocular tube of the assistant's microscope
19 Focusing knob
for adjusting the assistant's microscope independently of the main
surgeon.
20 Five-step manual magnification changer
21 Screw
for locking the assistant's microscope within its 15° tilt range.
– Button pressed magnetic brakes are released, the unit
can be moved as required.
– Button released magnetic brakes are locked, the unit
cannot be moved.
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Description 33
14
15
16
17
18
19
20 21
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22 Light stop knob
23 Adjusting lever for the 6° illumination
for gradual fading in/out of the coaxial illumination. Fading out the 6°
illumination improves the visualization of structures in retro-illumination.
24 Connector socket for S light guide
25 Locking screw for assistant's microscope
for locking the assistant's microscope in both working positions on the
right and left of the main microscope.
Retro-illumination contrast stop.
This stop reduces the straylight reflected from the sclera.
Diameter approx. 16 mm (with objective lens f = 200 mm): Free
passage.
Diameter over approx. 16 mm: Partially transmitting periphery.
Free passage. The field of view is fully illuminated.
Retinal protection device. This device does not snap in, i.e. it
can be moved continuously in the image.
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Description 35
22 23 2524
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Hand grips (option)
In addition to the maneuvering grips provided, larger hand grips can be
mounted. The mounting procedure is described in the instructions enclosed.
This does not affect the functioning of the surgical microscope. Only the
operation of the surgical microscope is slightly changed.
1 Maneuvering grip with integrated release button
By turning one of the two maneuvering grips you will activate the
button for magnetic brakes of the suspension system.
(Only in combination with suspension systems with magnetic brakes
(e.g. S8 Floor Stand)).
2 Knob for adjusting the red reflex illumination
By sliding the knob, you can switch the angle of illumination between
+ 2° and - 2°.
– Button pressed Magnetic brakes are released, the unit
can be moved as required.
– Button released Magnetic brakes are locked, the unit
cannot be moved.
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Description 37
1
2
1
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Tube and eyepieces for main microscope
1 180° tiltable tube
2 PD adjustment knob
The correct interpupillary distance has been set when both eyepiece
images merge into one.
3 Push-in widefield eyepiece
Note:
When you remove the eyepiece from the tube, please note that this
eyepiece is fitted with a magnetic coupling. When mounted, the eyepieces display a very weak magnetic field. For this reason, the usual
rules for the handling of magnets must only be observed with eyepieces which have not been mounted on the microscope:
• Do not place the eyepieces close to instruments where there is any
risk of magnetization.
• Do not place eyepieces on sensitive electronic instruments such as infusion pumps, cardiac pace-makers, measuring instruments or magnetic data carriers such as disks, audiotapes and videotapes or credit
cards.
• Always store the eyepieces in their original packaging when not in
use.
4 Eyecup
Always adjust the eyecups in such a way that you can see the full field
of view.
5 Diopter setting ring
The eyepieces provide ametropia compensation from -8 D to +5 D. If
you wear your eyeglasses during work, adjust the ring to 0 D. Turn the
ring until you have found the optimum setting. A built-in catch lever
locks the ring in the position set.
6 Diopter scale
For reading the prescription set.
– Viewing with
eyeglasses:
Screw in eyecups all the way.
– Viewing without
eyeglasses:
Screw eyecups outward until you can
see the full field of view.
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Description 39
1
2
4
5
6
3
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Tube and eyepieces for assistant's microscope
7 Push-in widefield eyepiece
Note:
When you remove the eyepiece from the tube, please note that this
eyepiece is fitted with a magnetic coupling. When mounted, the eyepieces display a very weak magnetic field. For this reason, the usual
rules for the handling of magnets must only be observed with eyepieces which have not been mounted on the microscope:
• Do not place the eyepieces close to instruments where there is any
risk of magnetization.
• Do not place eyepieces on sensitive electronic instruments such as infusion pumps, cardiac pace-makers, measuring instruments or magnetic data carriers such as disks, audiotapes and videotapes or credit
cards.
• Always store the eyepieces in their original packaging when not in
use.
8 Eyecup
Always adjust the eyecups in such a way that you can see the full field
of view.
9 Diopter scale
For reading the prescription set.
10 Diopter setting ring
The eyepieces provide ametropia compensation from -8 D to +5 D.If
you wear your eyeglasses during work, adjust the ring to 0 D. Turn the
ring until you have found the optimum setting. A built-in catch lever
locks the ring in the position set.
11 Binocular assistant's microscope
Note:
Always use the assistant's microscope with the appropriate (shown)
binocular assistant's tube. If you use a different tube, you will obtain
an inverted image.
– Viewing with eyeglass-
es:
Screw in eyecups all the way.
– Viewing w/out eyeglass-
es:
Screw eyecups outward until you see
the full field of view.
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Description 41
7
8
9
10
11
Page 42
42 Description
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Page 43
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Attaching the equipment 43
Attaching the equipment
Mounting the binocular tubes, eyepieces and the objective lens 44
Page 44
44 Attaching the equipment
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Mounting the binocular tubes, eyepieces and the objective lens
Note:
Always use the assistant's microscope with the appropriate binocular assistant's tube (shown). If you use a different tube, you will obtain an inverted image.
• Loosen securing screw (5) by a few turns.
• Remove cover (1) and store it in a safe place.
• Place binocular tube (2) on the surgical microscope and tighten secu-
ring screw (5) firmly.
• You can install other units between the binocular tube and the microscope body. Lock these units in position in the same way using securing screw (5).
• Place binocular tube (10) on the assistant's microscope and tighten
securing screw (7)firmly.
• You can install other units between the binocular tube and the microscope body (e.g. an optical wedge, 30°). Lock these units in position
in the same way using securing screw (7).
• Insert 12.5x widefield eyepieces (4) into the mounts intended for them
(3) as far as they will go. The magnetic coupling reliably secures them
in position.
• Insert 10x widefield eyepieces (9) into the mounts intended for them
(8) as far as they will go. The magnetic coupling reliably secures them
in position.
Note:
If a documentation device is used, one of the eyepieces can be delivered
with a reticle to aid focusing. Retrofitting the reticle can only be performed
at the factory or by our service representative. Always use the eyepiece
with reticle on the same side of the binocular tube as the documentation
device is installed.
• Screw objective lens (6) into the microscope body and tighten itfirmly.
Page 45
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Attaching the equipment 45
Caution:
Before using and after re-equipping the unit, make sure that the two binocular tubes (2 and 10) are securely locked in position. Make sure that
– securing screws (5 and 7) and
– objective lens (6)
have been tightened firmly
.
1
2
4
6
5
10
9
7
8
3
Page 46
46 Attaching the equipment
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Page 47
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
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Operation 47
Operation
Preparations for use 48
Adjusting the tilt angle 48
Adjusting the surgical microscope 49
Checklist 50
When using a fundus imaging system (e.g. BIOM II) 52
Procedure 53
What to do in an emergency 55
Failure of zoom system 55
Failure of X-Y coupling 56
Failure of focusing system 56
Page 48
48 Operation
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Preparations for use
Adjusting the tilt angle
Using knob (1), you can position the surgical microscope in a range from
+ 15° to - 90° (+ 15° in the direction of the surgeon and - 90° in the opposite direction). The 90° setting is ideal for surgery on patients in a seated
position or lying on their side.
• Using locking screw (2). secure the assistant's microscope in the
working position set (on the left or right of the main microscope).
• Turn knob (1) until the surgical microscope is in the position required.
After the viewing angle has been set, the surgical microscope remains in
this position. The gear drive is self-locking.
2
1
Page 49
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
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Operation 49
Adjusting the surgical microscope
Bring the surgical microscope into starting position within the focusing range. Set the minimum magnification on the surgical microscope. Bring the surgical microscope into working position. Adjust the interpupillary distance on the binocular tube. Set the diopter scales on the eyepieces. Please note that instrument myopia may occur.
Emmetropes
set the diopter scale to 0 diopter (D).
Eyeglass wearers
(who perform surgery wearing their
glasses) set the diopter scale to 0 diopter (D).
Ametropes
(who know their refractive powers
and perform surgery without wearing their glasses) set the diopter
scale ring to their refractive powers.
Set both eyepieces on the main microscope to +5 D.
Set both eyepieces on the assistant’s
microscope to +5 D (if applicable).
Eyepieces without
reticles:
Eyepieces with
reticles:
Turn the diopter scale ring on the eyepiece slowly clockwise until the reticle is
imaged sharply. Stop turning the ring.
Turn the diopter scale ring of one
eyepiece slowly
clockwise until the
image of the object is sharp. Stop
turning the ring. If necessary, repeat
this procedure three times and take
the average of the readings found.
Adjust the second eyepiece in the
same manner.
Focus the surgical microscope on the
object. The reticle and the object must
be imaged sharply at the same time.
Replace the tube and eyepieces on
the microscope body and firmly
tighten the securing screw.
Adjust the second eyepiece in the same
way until the object is seen sharply.
Adjust the eyecups in such a way that the full field of view can be seen. Set the maximum magnification on the microscope and focus
on the object. Set the working magnification required. When the magnification is changed, the focal plane is retained, but the depth
of field changes.
Note
: If several surgeons use the instrument, it is advisable to draw up a table
showing the individual refractive powers of each surgeon and to keep it in a handy
location near the instrument.
*) CAUTION: Never
point the eyepieces at the sun!
Ametropes (who do not know their refractive powers and perform surgery without wearing their glasses):
Set both eyepieces on the main microscope to +5 D.
Set both eyepieces on the assistant’s
microscope to +5 D (if applicable).
Remove the binocular tube and
eyepieces from the microscope
body and point them at a distant object
*)
, i.e. use them like a pair of bi-
noculars.The image of the object is
still unsharp.
Page 50
50 Operation
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Checklist
Always check the following points before surgery (without the patient!):
VISU 200 surgical microscope
– Check that the correct rated voltage has been set for the suspension
system.
– Check that all cables have been connected.
– Check that the light guide has been connected.
• Turn on the instrument at the power switch of the suspension system.
Note:
After the system has been switched on, the S8 suspension system(ophthalmology) automatically performs a self-test. The self-test is completed
after approx. five seconds.
Zoom
– Check this function using the appropriate key on the foot control panel.
Focus
– Check this function using the appropriate key on the foot control panel.
Friction adjustment of the surgical microscope
– Check that the friction of the surgical microscope's rotation has been
adjusted as required using the friction adjustment knob on the suspension system.
Locking the assistant's microscope in position
– Check that the assistant's microscope is locked in the working position
required (on the right or left of the main microscope).
Speeds of the surgical microscope's functions
(only in connection with S8 suspension system (ophthalmology))
– Check that the speeds of the microscope's functions have been set as
required on the S8 suspension system (ophthalmology).
Eyepieces / Tiltable binocular tubes
– Check that the tiltable tube of the main microscope and the assistant's
microscope are in positions convenient for you.
– Check that the correct interpupillary distance has been set.
– Check that the eyecups have been adjusted in such a way that you
can see the full field of view.
– Check that the correct prescription has been set on the diopter scale.
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Operation 51
– Check that image quality is the same throughout the entire magnifica-
tion range.
Accessories
– Using the relevant user's manuals, check that the other equipment (il-
lumination system, video system, etc.) is working properly.
Warning!
If a function fails, you must not use this instrument for safety reasons. Correct the fault (see the "Troubleshooting table“) or contact our service dept.
Page 52
52 Operation
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
When using a fundus imaging system (e.g. BIOM II)
When using a fundus imaging system (e.g. BIOM II from the company 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 stand arm.
Only use accessories expressly certified by the manufacturer for combination with the surgical microscope described in this manual.
Caution!
• With the fundus imaging 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 towards the surgical field until you see
the patient's cornea sharply defined.
• Turn the screw for limiting the downward movement clockwise as far
as it will go.
• It is vital that you read the user’s manual on the fundus imaging system (e.g. BIOM II from the company Oculus).
1
2
Risk of collision!
Page 53
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
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Operation 53
Procedure
• Turn on the power switch of the suspension system.
• Adjust the brightness of the surgical field illumination as required on
the stand.
• Check the unit using the checklist.
• Move the surgical microscope over the surgical field and bring it into a
convenient position within the working distance.
• Press the activator button.
– The X-Y coupling is recentered.
– The focus is reset to its initial position in the focusing range.
• Select the lowest magnification (zoom function on the foot control panel).
• For coarse focusing, look through the eyepieces and lower the surgical microscope using the suspension arm until the surgical field comes
into focus.
• Select the highest magnification (zoom function on the foot control
panel).
• Look through the eyepieces and activate the focusing function on the
foot control panel until the microscope is sharply focused on the surgical field.
• Select the magnification required (zoom). Look through the eyepieces
of the binocular tube. Adjust the eyepieces (including those of the assistant's microscope) in such a way that you can see both the edge of
the field of view and the microscope image sharply. Also see “Adjusting the surgical microscope“.
• Switch the unit off when it is not in use.
Page 54
54 Operation
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Caution!
– Avoid looking directly into the light source, e.g. into the microscope ob-
jective lens or into a fiber light guide!
– When selecting the brightness level for the patient's eye, always take
care to keep the strain on the patient's eye to a minimum.
– If the red reflex is not necessary, move the retinal protection device
into the beam path. Only use the retro-illumination contrast stop, if the
surgical procedure requires a red reflex.
– When operating on the eye, always use a GG 475 protection filter to
ensure that the patient's eye is not exposed to unnecessary (blue) radiation (retinal injury).
Page 55
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Operation 55
What to do in an emergency
Failure of zoom system
• Manually adjust the magnification using zoom control (1) on the microscope (if necessary, use a tool, e.g. screwdriver, coin, etc.).
1
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56 Operation
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Failure of X-Y coupling
• If the X-Y coupling fails, you can manually position the surgical microscope utilizing the possibilities of the suspension system you are using.
Failure of focusing system
• Disconnect the cable between the surgical microscope and the suspension system (illumination continues to be on.)
• Focus the surgical microscope by moving the suspension arm or the
lift arm of the suspension system you are using.
Page 57
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Maintenance / Further information 57
Maintenance / Further information
Trouble-shooting 58
Magnifications / Fields of view 60
Care of the unit 61
Sterilization 62
Ordering data 63
Spare parts 64
Accessories 64
Adapter cables 66
Technical data 67
Ambient requirements 69
Page 58
58 Maintenance / Further information
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Trouble-shooting
• This instrument is a high-grade technological product. To ensure optimum performance and safe working order of the instrument, its safety
must be checked once every 12 months. We recommend having this
check performed by our service representative as part of regular maintenance work.
If a failure occurs which you cannot correct using the trouble-shooting
table, attach a sign to the instrument stating it is out of order and contact our service representative.
VISU 200 Surgical Microscope
Problem Possible cause See
No function at all. Power cord of suspension
system not plugged in.
Plug in power cord. -
Power switch of suspension
system not on.
Press power switch. Green
light in power switch must
come on.
-
Circuit breaker in suspension system power switch
activated.
Press power switch again. -
Line power failure. Contact in-house electri-
cian.
-
Lamp module has no contact.
Insert lamp module as far as
it will go.
-
Surgical field illumination at
microscope inoperative.
Illumination system of suspension system not
switched on.
Switch on illumination
system of suspension
system.
-
S light guide not properly inserted in lamp or microscope.
Insert S light guide as far as
it will go.
-
Failure of suspension
system electronics.
Illuminate surgical field
using an OR illuminator.
Contact service dept.
-
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Maintenance / Further information 59
Insufficient surgical field illumination.
Brightness level set too low. Adjust brightness on sus-
pension system or using
foot control panel.
-
Defective S light guide (no
homogeneous illumination).
Contact service dept.
The light guide must probably be changed.
-
Focusing function inoperative.
Connectors on suspension
system not correctly inserted.
Plug in connectors correctly. -
Focusing system always
moves into upper or lower
end position.
Check suspension system.
Move the suspension arm to
adjust the focus.
Contact service dept.
-
Zoom function inoperative. Connectors on suspension
system not correctly inserted.
Plug in connectors correctly. -
Zoom system always moves
into upper or lower end position.
Check suspension system.
Manually adjust magnification using the zoom knob.
Contact service dept.
page 32
X-Y coupling inoperative. Connectors on suspension
system not correctly inserted.
Plug in connectors correctly. –
Defective motor. Position microscope manu-
ally.
Contact service dept.
-
X-Y coupling always moves
in opposite direction.
Function not correctly adjusted on suspension
system.
Check suspension system. -
Zoom and focusing functions inoperative.
Functions not correctly adjusted on suspension
system.
Check suspension system. -
Microscope motion too stiff. Friction adjustment knob on
suspension system tightened too firmly.
Loosen friction adjustment. -
Problem Possible cause See
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60 Maintenance / Further information
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Magnifications / Fields of view
Using the magnification factor γ of the zoom system, you can calculate the
total magnification of the surgical microscope according to the following
formula:
where:
f
tube
is the focal length of the binocular tube
f
obj
is the focal length of the main objective lens
γ is the magnification factor set on the zoom system
M
eye
is the magnification of the eyepiece
Example:
f
tube
= 170 mm, f
obj
= 200 mm, γ = 1.6 and M
eye
= 12.5 x.
The resulting total magnification is:
If the total magnification M
T
of the surgical microscope is known, the field-
of-view diameter FoV
D
can be calculated using the formula:
The field-of-view diameter FoV
D
is the diameter of the circular area of the
surgical field which can be seen through the eyepieces.
FoV
N
in the above formula stands for the field-of-view number of the eye-
piece. This number is marked on our widefield eyepieces.
Using M
T
= 17.0 from the example above, the field-of-view diameter ob-
tained with a 12.5x eyepiece with a field-of-view number FoV
N
of 18 mm
is calculated as follows:
M
T
f
tube
f
obj
-----------
γ M
eye
⋅⋅=
M
T
170 mm
200 mm
---------------------
1.6 12.5 17.0=⋅⋅=
FoV
D
FoV
N
M
eye
⋅
M
T
------------------------------------=
FoV
D
18 mm 12.5⋅
17.0
-------------------------------------
13.2 mm==
Page 61
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Maintenance / Further information 61
Care of the unit
Cleaning optical surfaces
The multilayer T* (T-star) coating of our optical components (e.g. eyepieces, objective lenses) results in optimum image quality.
Image quality is impaired by even slight contamination of the optics or by
a fingerprint. In order to protect the internal optics from dust, the instrument should never be left without the objective lens, binocular tube and
eyepieces installed when it is not in use. Always store objective lenses,
eyepieces and accessories which are not being used in dust-free cases.
The external surfaces of optical components (eyepieces, objective
lenses) should only be cleaned when required:
• Do not use any chemical cleaning agents.
• Blow off dust on the optical surfaces using a squeeze blower or remove the dust using a clean and grease-free brush.
Prevention of fogging
To prevent the eyepieces from fogging, you may treat them with our antifogging agent.
This anti-fogging agent consists of a dry, chemical solid in the form of a
stick and produces a dry film when applied to the eyepieces.
This film protects against fogging without causing any damage to the T*
coating. The anti-fogging agent contains neither wax nor silicone; it is unpoisonous and does not scratch glass.
The anti-fogging agent does not only ensure fog-free optics; it cleans and
protects the eyepiece optics against dirt, grease, dust, fluff and fingerprints.
Every pack of anti-fogging agent (contains 1 stick) includes instructions
for use which we would ask you to observe.
Important:
Spread the anti-fogging agent film with a dry cotton cloth - do not use
paper!
Anti-fogging agent: Cat. No. 30 55 50- 9910
Cleaning mechanical surfaces
All mechanical surfaces of the equipment can be cleaned by wiping with
a moist cloth. Do not use any aggressive or abrasive cleaning agents.
Wipe off any residue with a mixture of 50% ethyl alcohol and 50% distilled
water plus a dash of household dish-washing liquid.
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62 Maintenance / Further information
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Sterilization
The asepsis sets supplied by Carl Zeiss contain rubber caps, sleeves and
hand grips which can be sterilized in autoclaves. We recommend the following program for sterilization:
Sterile single-use drapes are available to cover the instrument.
Note
:
When draping the system, make sure that there is enough slack to allow
for movement of the microscope carrier and the surgical microscope. It is
especially important that the drapes are completely loose around the
hand grips. The surgeon must be able to operate the keys through the
drapes.
Sterilization temperature: 120° C
Sterilization time: 20 minutes
Page 63
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Maintenance / Further information 63
Ordering data
VISU 200 Surgical Microscope
Description Cat. No.
VISU 200 Surgical Microscope including X-Y coupling
and assistant's microscope
1050-462
180° tiltable tube 30 37 91-0000
10x eyepiece for assistant's microscope (2x) 30 55 42-0000
12.5x/18 B eyepiece for main microscope (2x) 30 55 43-0000
Objective lens f = 175 mm 30 26 51-9902
Dust cover 1055-278
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64 Maintenance / Further information
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
Spare parts
VISU 200 Surgical Microscope
Accessories
Please observe the following:
Only operate the instrument with the accessories included in the delivery
package. If you want to use other accessories, make sure that Carl Zeiss
or the manufacturer of the accessories has proved and confirmed that
these accessories meet the respective technical safety standards and
can be used without risk.
Description Cat. No.
S light guide (not shown) 2.0 m 30 34 81-9020
Dust cover (not shown) 1055-278
Asepsis set (not shown) 1009.100
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Maintenance / Further information 65
VISU 200 Surgical Microscope
Description Cat. No.
1 Objective lens, f = 200 mm 30 26 52-9903
2 Optical wedge, 30° 1006-145
3 Sleeve (for insertion of eyepiece (4)) 30 55 42-0107
4 10x eyepiece with magnetic coupling 30 55 42-0000
5 OPMI VISU hand grips 1049- 171
Asepsis for OPMI VISU hand grips
(1x included in delivery package 1049- 171)
1054- 074
12345
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66 Maintenance / Further information
G30-1298-en VISU 200 Surgical Microscope Issue 2.0
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Adapter cables
for the electrical connection of the surgical microscope to different types
of suspension system.
Cat. No.
1 EMD II Electromechanical Ceiling Mount 30 26 02- 9053
1 S3 Ceiling Mount 30 26 02- 9053
2 S4 Ceiling Mount 30 26 02- 9054
1 S23 Ceiling Mount 30 26 02- 9053
3 S6 Ceiling Mount 30 26 02- 9055
3 S61 Ceiling Mount 30 26 02- 9055
1 S22 Floor Stand 30 26 02- 9053
2 S4 Floor Stand 30 26 02- 9054
1 S3 Floor Stand 30 26 02- 9053
123
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Maintenance / Further information 67
Technical data
VISU 200 Surgical Microscope
Optical data
Magnification Main microscope:
4.9x - 29x
Motorized zoom system with apochromatic optics, 1:6 zoom ratio,
magnification factor γ = 0.4x - 2.4x.
Focusing Motorized, focusing range 50 mm
At the press of a button, the focusing drive returns
to its initial position.
Objective lens focal
length
f = 175 mm (option: f = 200 mm)
Tubes / Eyepieces Main microscope
:
180° tiltable binocular tube, f=170 mm. 12.5x
screw-type, widefield eyepieces (option: 10x ).
Assistant's microscope
:
5-step magnification changer, separate fine focusing, adjustable tilt.
Binocular tube, can be turned by ±12° about its
optical axis,
10x widefield eyepieces with magnetic coupling.
Illumination Fiber illumination with two lamp modules, each
with two 12 V 100 W halogen reflector lamps,
fully automatic lamp change in the event of lamp
failure,
filter against UV exposure,
protection against IR exposure,
6° illumination (continuous fading),
patented 2° illumination for red reflex, usable in
+2° and -2° positions
Pat. No. DE40 28 60 5 C2
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68 Maintenance / Further information
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Mechanical data
Swing-in stops Patented retinal protection device,
Pat. No. DE 33 39 17 2 C2
Patented field stop for reduced glare,
Pat. No. G 91 03 43 3.7
Microscope tilt With torque compensation, manually adjustable
using knob.
Friction manually adjustable until tilt axis is
locked.
Tilt angle ± 15°.
Swivel range of assistant's microscope
Swivel range ± 90°, manually lockable
X-Y coupling Adjustment range: max. 40 mm x 40 mm,
automatic recentering at the press of a button.
Weight Approx. 13 kg
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Maintenance / Further information 69
Ambient requirements
Subject to change.
For operation Temperature
Rel. humidity
Air pressure
+10 °C...+40 °C
30%...75%
700 hPa...1,060 hPa
For transportation and
storage
Temperature
Rel. humidity
(without
condensation)
Air pressure
- 40 °C...+70 °C
10%...100%
500 hPa...1,060 hPa
The unit meets the essential requirements stipulated in Annex I to the 93/42/EEC Directive governing medical devices. The unit is marked with:
Page 70
70 Maintenance / Further information
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Page 71
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Index 71
Index
Numerics
0° assistant's microscope
24
2° illumination 26
90° position 48
A
Accessories
64
Accident prevention regulations 8
Activator button 28
Adapter cables 66
Adjusting lever for 6° illumination 34
Adjusting the balance setting of the tilt motion 48
Adjusting the surgical microscope 49
Ambient requirements 69
Angle of illumination 13
Anti-fogging agent 61
B
Binocular tubes, eyepieces and objective lens, mounting of
44
Buttons for the release of the magnetic brakes 30
C
Care of the unit
61
CE marking 69
Checklist 50
Cleaning optical surfaces 61
Clip for cable and light guide 28
Composition, spectral 13
Connector socket for S light guide 34
Controls, displays, connections 28
D
Description
17, 43
Description of the modules of OPMI VISU 200 18
Diopter scale 38, 40
Directive 93/42/EEC 69
Directives 8
E
Emergency backup line supply
8
Exposure time to light 14
Eyecup 38, 40
F
Failure of a function
51
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72 Index
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Failure of zoom system 55
Fields of view 60
Focus of the light source 13
Focusing knob 32
Focusing system failure 56
Fogging, prevention 61
Fundus imaging system 12, 52
G
GG 475 eye protection filter
14
GG 475 protection filter 11
H
Hand grips (option)
36
I
Illumination characteristics
13
Indicator marks for focusing range 28
Installation, notes 9
Instrument class 8
Instrument connector 28
Intensity of illumination 13
K
Key to symbols
2
Knob for adjusting the red reflex illumination 32
L
Light source, focus
13
Light stop knob 34
Locking screw for assistant's microscope 24, 34
M
Magnification changer
32
Magnifications 60
Main microscope 20
Main microscope, tilted 24
Maintenance 57
Manual adjustment of zoom system 32
Mechanical surfaces, cleaning 61
Microscope pivot 28
Mobile phones 9
N
Notes on safety
8
Notes on use 9
O
Operation
47
Operation, requirements 10
Ordering data 63
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Index 73
P
PD adjustment knob
38
Phototoxic retinal injury in eye surgery 12
Potential equalization 9
Prevention of fogging 61
Procedure 53
Protective ground contact 10
Q
Quality management system
8
R
Red reflex illumination
36
Re-equipping the instrument 10
Release button for magnetic brakes 32, 36
Requirements for operation 10
Risk of collision! 12, 52
S
Safety
7, 8
Safety check 10, 58
Safety standards 8
Spare parts 64
Spectral composition 13
Standards 8
Sterilization 62
Support arm for the surgical microscope 20
Support arm with tilt device 28
T
Technical data
67
Time of exposure to light 14
Trouble-shooting table 58
Tube and eyepieces for assistant's microscope 40
Tube and eyepieces for main microscope 38
U
Use of the instrument, before
10
Use of the instrument, for every 11
Use, notes 9
W
What to do in an emergency
55
X
X-Y coupling
18, 28
X-Y coupling failure 56
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74 Index
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G30-1298-en VISU 200 Surgical Microscope Issue 2.0
Printed on 09. 11. 2006
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Carl Zeiss
Surgical Products Division
73446 Oberkochen
Germany
Fax: +49 (0) 7364/20-4823
email: surgical@zeiss.de
www.zeiss.de
G30-1298-en Printed in Germany MS-TD
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