EyeWorld India December 2018 Issue

26 EWAP FEATURE December 2018 Additionally, the elimination of the need to remove an IV, a smooth patient recovery, and their ability to quickly leave the postop area once all assessments are met are other advantages Dr. Berdahl sees. Dr. Greenwood has seen ad- ditional patient benefit from the anti-nausea effect of ondansetron. He also views as an advantage the melt’s availability to be ordered in 503B, which allows bulk orders without the need for individual prescriptions. Limitations The melt’s primary disadvantage, Mr. Bender said, is the difficulty to redose or supplement the sedation once the procedure is started. That concern was echoed by the surgeons. “The disadvantages are that there isn’t a safety blanket of the IV in the hand, however, anesthe- tists and nurses are quite adept at giving an IV in the operating room if it’s needed, which is rare,” Dr. Berdahl said. The need to start an IV occurs in fewer than 1% of Dr. Berdahl’s patients. MKO Melt Source: Chris Bender, CRNA The only time Dr. Greenwood supplements the melt with an IV is in his cataract plus DMEK cases because there is a chance such surgeries will take a few extra minutes, and the IV allows the patient to get some additional anesthesia, if needed. About 5% of the patients get additional medica- tions. “The times I don’t use MKO Melt are when I am going to do a block for a PKP or other complex surgery,” Dr. Greenwood said. “These patients have an IV for the block so we use traditional anes- thetic.” Mr. Bender said there is a learning curve to using the MKO Melt. “Once practitioners get a good understanding of how patients respond to the dosing and timing of administration, supplementa- tion with IV medications becomes rare,” Mr. Bender said. Patient feedback A number of patients have sought out Dr. Berdahl’s practice due to severe needle phobias and because they heard he offered cataract sur- gery without the need for an IV. “In general, patients enjoy it,” Dr. Greenwood said. “They are comfortable, relaxed, and don’t recall much from the surgery. Among the few comments Dr. Greenwood has received is that some patients don’t like the taste, but they much prefer that over insertion of an IV. “They enjoy not having the IV,” Dr. Greenwood said. EWAP Editors’ note: Mr. Bender and Dr. Berdahl have financial interests with Imprimis Pharmaceuticals. Dr. Green- wood has no financial interests related to his comments. Contact information Greenwood: michael.greenwood@vancetho mpsonvision.com Berdahl: john.berdahl@vancethompsonvision. com Bender: chris.bender@vancethompsonvision. com MKO Melt – from page 25