Zeiss VISU 200 User manual

OPMI®VISU 200 BrightFlex™
Surgical Microscope
Instructions for use
G-30-1439-en
Issue 3.0
Printed on 21. 11. 2002

G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
Contents
Functions at a glance 5
– VISU 200 BrightFlex™ surgical microscope 6
– Key to symbols 7
Safety 9
– Directives and standards 10
– Notes on installation and use 11
– When using a fundus imaging system (e.g. BIOM II) 14
– Phototoxic retinal injury in eye surgery 14
– Warning labels and notes 18
Description 19
VISU 200 BrightFlex™ Surgical Microscope 20
– Intended use 20
– Description of the modules 20
– Illumination system 28
– Controls, displays, connections 30
– Hand grips (option) 38
– Tube and eyepieces for main microscope 40
– Tube and eyepieces for assistant's microscope 42
Preparations for use 45
– Mounting the binocular tubes, eyepieces and the objective lens 46
Operation 49
Preparations for use 50
– Adjusting the tilt angle 50
– Setting the microscope tilt to angles greater than 15° 52
– Adjusting the surgical microscope 53
– Checklist 54
– When using a fundus imaging system (e.g. BIOM II) 56

G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
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Procedure 57
What to do in an emergency 59
– Failure of zoom system 59
– Failure of X-Y coupling 60
– Failure of focusing system 60
Maintenance / Further information 61
– Trouble-shooting table 62
– Magnifications / Fields of view 64
– Care of the unit 65
– Sterilization 66
– Ordering data 67
– Spare parts 68
– Accessories 68
– Adapter cables 70
Technical data 71
– Technical data 72
– Ambient requirements 74
Index 75

G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
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Functions at a glance 5
Functions at a glance
VISU 200 BrightFlex™ surgical microscope 6
Key to symbols 7

6Functions at a glance
G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
VISU 200 BrightFlex™ surgical microscope
1 Resetting the X-Y coupling, focus and zoom to their initial
positions Page 30
2 Adjusting the tilt of the surgical microscope Page 50
3 Setting the interpupillary distance Page 40
4 Adjusting the eyecups Page 40
5 Setting your prescription Page 40
6 Display of the magnification factor of the zoom system Page 32
7 Setting the red reflex illumination (+2° and -2°) Page 28
8 Releasing the magnetic brakes of the suspension system Page 32
9 Changing the magnification on assistant's microscope Page 34
10 Focusing of assistant's microscope Page 34
11 Setting the 6° illumination Page 36
12 Arrows indicating the focusing range Pages
30, 56
13 Locking screw for assistant's microscope (vertical) Page 34
14 Selecting light stops Page 36
15 Connecting the light guide Page 36
16 Locking screw for assistant's microscope (horizontal) Page 36
1
2
3
4
5
67 9 10 5 4 11 12 9 13 14 15 16108 8

G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
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Functions at a glance 7
Key to symbols
Different symbols used in this user's manual draw your attention to safety
aspects and useful tips. The 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 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.
OPMI®

8Functions at a glance
G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
Printed on 21. 11. 2002

G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
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Safety 9
Safety
Directives and standards 10
Notes on installation and use 11
When using a fundus imaging system (e.g. BIOM II) 14
Phototoxic retinal injury in eye surgery 14
Warning labels and notes 18

10 Safety
G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
The instrument described in this manual has been developed and tested
in accordance with Carl Zeiss safety standards and with national and in-
ternational regulations. A high degree of instrument safety is thus en-
sured.
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 exclama-
tion 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 in-
strument. You may obtain further information from our service organiza-
tion or authorized representatives.
Directives and standards
The instrument described in this manual has been designed in compli-
ance with the following standards:
–EN
–IEC
–UL
–CSA
In accordance with Directive 93/42/EEC, the complete quality manage-
ment system of the company Carl Zeiss has been certified by the DQS
Deutsche Gesellschaft zur Zertifizierung von Managementsystemen
mbH, a notified body, under registration number 250758 MR2.
• The instrument must be connected to a special emergency backup
line supply in accordance with the regulations or directives which ap-
ply in your country.
• This is a class I instrument as defined by Directive 93/42 /EEC.
• Please observe all applicable accident prevention regulations.

G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
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Safety 11
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 represent-
ative 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 poten-
tial equalization measures. For this purpose, contact our service de-
partment.
• Do not use a mobile phone in the vicinity of the equipment because
the radio interference can cause the equipment to malfunction. The ef-
fects 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 for-
feit 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.

12 Safety
G-30-1439-en OPMI® VISU 200 BrightFlex™ Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
• Only personnel who have undergone training and instruction are al-
lowed 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 opti-
mum 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 main-
tenance 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 con-
tact 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 opera-
tion 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 tight-
ened.
–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 earth contact.
–Thepowercordbeingusedistheonedesignedforusewiththisin-
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 re-
moved or opened.

G-30-1439-en OPMI®VISU 200 BrightFlex™Surgical Microscope Issue 3.0
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Safety 13
•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 ob-
jective 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).

14 Safety
G-30-1439-en OPMI®VISU 200 BrightFlex™Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
When using a fundus imaging system (e.g. BIOM II)
When using a fundus imaging system (e.g. BIOM II from the company Oc-
ulus) 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 combi-
nation 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 micro-
scope'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 sys-
tem (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 photo-
toxicity 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
12
Risk of collision!

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Safety 15
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 in-
struments.
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 micro-
scopes 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 sur-
gery.
Carl Zeiss has addressed this concern by providing a device for continu-
ously 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.

16 Safety
G-30-1439-en OPMI®VISU 200 BrightFlex™Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
This is the reason why fiber optic illumination is used in surgical micro-
scopes 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 recom-
mended in ophthalmic surgery to keep the light intensity as low as pos-
sible, or to use a device which prevents the light from entering through the
patient's pupil. Also, the surrounding light sources should not cause addi-
tional strain to the patient's eye.
Carl Zeiss has provided an answer to this problem in the form of a swing-
in 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.
Intensity scale
The intensity scale of our suspension system is calibrated in units of the
”Spectrally weighted radiance for the photochemical hazard of the phakic
eye (LB)”
LBis the spectral radiance integrated over the spectral range from 380 nm
to 700 nm and weighted with B(λ):
in which B(λ) is the spectral weighting function for the photochemical ha-
zard of the retina of the phakic eye.
The value LB=500mW/cm²sr is the reference value and is defined as
1.0 on the intensity scale of the suspension system as recommended in
the ISO 10936-2 standard draft for surgical microscopes used in oph-
thalmic applications. At this reference value, photoretinitis might be ex-
pected to occur from the surgical microscope light source in a total retinal
exposure time of 10 minutes. This applies to the exposure of a specific
point on the retina with an uninterrupted illumination beam. In a cataract
procedure, instruments such as the phacoemulsification handpiece, the
700
LB=
∑ L(λ)B(λ)∆λ
380

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Safety 17
use of fluids in the eye, manipulation and movement of the eye, among
other factors, result in the interruption of the illumination from the surgical
microscope light source. Such factors would be expected to significantly
extend the time at which photoretinitis might occur.
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 pho-
totoxic retinal injury.
Note:
The VISU 150 microscope always contains a UV blocking filter.
The use of this filter ensures that the illumination intensity lies below 50
µW/cm2in the range between 305 nm and 400 nm.
These measures help the surgeon to reduce the risk of phototoxic retinal
injury.

18 Safety
G-30-1439-en OPMI®VISU 200 BrightFlex™Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
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.

G-30-1439-en OPMI®VISU 200 BrightFlex™Surgical Microscope Issue 3.0
Printedon21.11.2002
Description 19
Description
VISU 200 BrightFlex™ Surgical Microscope 20
Intended use 20
Description of the modules 20
Illumination system 28
Controls, displays, connections 30
Hand grips (option) 38
Tube and eyepieces for main microscope 40
Tube and eyepieces for assistant's microscope 42

20 Description
G-30-1439-en OPMI®VISU 200 BrightFlex™Surgical Microscope Issue 3.0
Printed on 21. 11. 2002
VISU 200 BrightFlex™ Surgical Microscope
Intended use
The VISU 200 BrightFlex™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 surgical microscope is comprised of the following modules:
1X-Y coupling
The X-Y coupling allows fine, motorized positioning of the surgical mi-
croscope 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 suspension
system.
The X-Y coupling is provided with a recentering mechanism. When
you press the actuator button,
–the X-Y coupling adopts its center position,
–the focusing system of the surgical microscope is reset to its initial
position and
–the zoom system will set a preselected magnification factor if the
XYZ-RESfunctionhasbeenactivated(possiblewithS8suspen-
sion systems only).
You can also trigger the recentering movement using the foot control
panel..