EyeWorld India June 2020 Issue

EWAP JUNE 2020 29 CATARACT analysis. Whether the cost savings reported in this study persist if the costs of the physical labor and supplies were included in the analysis and whether similar cost savings can be replicated at other institutions would be interesting to explore in future studies given differences in purchasing power (i.e., different price of medications and devices), operating costs, and regulations (e.g., whether bottles of topical mydriatics could be reused between cases). As the authors note, topical mydriatics cannot be reused across cases in the Veterans Affairs system, and new bottles of these medications were used for each patient. At the authors’ institution, the most expensive topical mydriatic was «…i˜Þi«…Àˆ˜i >Ì 1-f{™°xä «iÀ case and amounting to a total œv 1-f£Î]ӣȰxä vœÀ V>Ãià vÀœ“ June through December 2017. In addition, while this ÃÌÕ`Þ Ã…œÜà È}˜ˆwV>˜Ì VœÃÌ savings between the two study groups, it would be interesting to see whether there were >˜Þ È}˜ˆwV>˜Ì `ˆvviÀi˜Vià ˆ˜ postoperative complications and outcomes that could impact overall cost per resident case. As the authors noted, there is a risk of dilution errors using intracameral mydriatics made by compounding pharmacies, which can result in corneal endothelium damage. Also, many institutions may not have access to compounding pharmacies onsite; those that have to obtain intracameral mydriatics from outside providers may incur higher costs than those reported in this study. Conclusion This retrospective review is ̅i wÀÃÌ ÃÌÕ`Þ Ìœ Vœ“«>Ài ̅i use of intracameral mydriatics to topical dilating drops with regard to surgical cost, PED use, >˜` ivwVˆi˜VÞ `ÕÀˆ˜} ÀiÈ`i˜Ì‡ performed cataract surgeries. Although the outcomes of the study may not be applicable to every practice, surgical protocols that include the use of intracameral mydriatics “>Þ ˆ“«ÀœÛi ivwVˆi˜VÞ ˆ˜ ̅i operating room and reduce surgical costs. This study can further be expanded to include a closer examination of postoperative outcomes and complication rates between the two groups, perhaps bolstering their claim of superiority of intracameral mydriatic use. EWAP References 1. Cionni RJ, et al. Cataract surgery without preoperative eyedrops. J Cataract Refract Surg. 2003;29:2281– 2283. 2. Myers WG, Shugar JK. Optimizing the intracameral dilation regimen for cataract surgery: prospective randomized comparison of 2 solutions. J Cataract Refract Surg. Óää™ÆÎx\ÓÇÎqÓÇÈ° 3. Lundberg B, Behndig A. Intracameral “Þ`Àˆ>̈Và ˆ˜ «…>Vœi“ՏÈwV>̈œ˜ cataract surgery – a 6-year follow-up. Acta Ophthalmol. 2013;91:243–246. 4. Visco D. Effect of phenylephrine/ Ži̜Àœ>V œ˜ ˆÀˆÃ wÝ>̈œ˜ Àˆ˜} ÕÃi >˜` surgical times in patients at risk of intraoperative miosis. Clin Ophthalmol. Óä£nÆ£Ó\Îä£q Îäx° x° 7ˆ˜ÌiÀ /7] iÌ >° ,iÈ`i˜Ì >˜` viœÜ participation in strabismus surgery: effect of level of training and number of assistants on operative time and cost. Ophthalmology. 2014;121:797–801. 6. Neff KD, et al. Factors associated ܈̅ˆ˜ÌÀ>œ«iÀ>̈Ûi yœ««Þ ˆÀˆÃ Ãޘ`Àœ“i° Ophthalmology. Óää™Æ££È\ÈxnqÈÈΰ Editors’ note: The authors would like to thank Leslie Hyman, PhD, Bruce Markovitz, MD, Beeran Meghpara, MD, Christopher Rapuano, MD, Zeba Syed, MD, Tara Uhler, MD, and Doug Wisner, MD, for their time and assistance in preparing this manuscript. Caroline Wilson, MD, Lauren Hock, MD, Thomas Oetting, MD, Sean Kennedy, BS, Daniel Terveen, MD J Cataract Refract Surg. ÓäÓäÆ{È{®\xÈÓqxÈÈ° Purpose: To compare the use of topical dilation drops versus topical drops with the addition of intracameral epinephrine in resident-performed cataract surgery and the effects on pupil expansion device (PED) use, surgical costs, and surgical times. Setting: Iowa City Veterans Affairs Medical Center, Iowa City, Iowa. Design: Retrospective chart review Methods: Resident-performed primary cataract surgical cases using topical dilation drops only or drops with the addition of intracameral epinephrine were analyzed for PED use, surgical Pupil expansion device use and operative outcomes with topical dilation versus intracameral epinephrine in resident-performed cataract surgery time, and costs in all patients and in patients with history of tamsulosin. Results: In the topical group, PEDs were used ˆ˜ Σ°£¯ V>Ãià Vœ“«>Ài` ̜ £Î°x¯ V>Ãià ˆ˜ the intracameral group ( p <0.0001). History of tamsulosin use was noted in about a third of cases in both groups. For patients with history of tamsulosin use, PED use decreased from xӰǯ ˆ˜ ̅i ̜«ˆV> V>Ãià ̜ £Ç°™¯ ˆ˜ ̅i intracameral group ( p <0.0001). Average surgical case times were on average 7.1 minutes slower with PED use than without PED use. There was > “i`ˆV>̈œ˜ Ã>ۈ˜}à œv fxä°{{ «iÀ V>Ãi ˆ˜ ̅i intracameral group compared to the topical group. Factoring in the $100–130 per PED used, total surgical costs were $19,267 less in the intracameral group over 6 months. Conclusion: Intracameral epinephrine with lidocaine decreases the need for pupil expansion device use during cataract surgery, lowers ˆ˜ÌÀ>œ«iÀ>̈Ûi VœÃÌÃ] >˜` ˆ“«ÀœÛià ivwVˆi˜VÞ compared to topical dilation drops alone.