Eyeworld

18 | EYEWORLD | APRIL 2020 ASCRS NEWS continued from page 17 Contact Uhler: Tara.Uhler@jefferson.edu Pupil expansion device use and operative outcomes with topical dilation versus intracameral epinephrine in resident-performed cataract surgery Caroline Wilson, MD, Lauren Hock, MD, Thomas Oetting, MD, Sean Kennedy, BS, Daniel Terveen, MD J Cataract Refract Surg. 2020;46(4):562–566. (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 52.7% in the topical cases to 17.9% in the 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 a medication savings of $50.44 per case in the 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. n Conclusion: Intracameral epinephrine with lidocaine decreases the need for pupil expansion device use during cataract surgery, lowers intraoperative costs, and improves efficiency compared to topical dilation drops alone. n 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. n Setting: Iowa City Veterans Affairs Medical Center, Iowa City, Iowa n Design: Retrospective chart review n 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 time, and costs in all patients and in patients with history of tamsulosin. n Results: In the topical group, PEDs were used in 31.1% cases compared to 13.5% cases in the intracameral group 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. savings with use of intracameral epinephrine with lidocaine versus topical dilation only at their institution. The authors note that the cost of pharmacy personnel and equipment required to prepare the intracameral epinephrine were not included in the cost 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 institu- tions 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 phenylephrine at $49.50 per case and amounting to a total of $13,216.50 for cases from June through December 2017. In addition, while this study shows signifi- cant cost savings between the two study groups, it would be interesting to see whether there were any significant differences in 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 endo- thelium 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 the first study to compare the use of intracameral mydriatics to topical dilating drops with regard to surgical cost, PED use, and efficiency during resi- dent-performed cataract surgeries. Although the outcomes of the study may not be appli- cable to every practice, surgical protocols that include the use of intracameral mydriatics may improve efficiency in the 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 bolster- ing their claim of superiority of intracameral mydriatic use.

• Blank Page
• Blank Page (1)