EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
Issue link: https://digital.eyeworld.org/i/555047
EW CATARACT 26 August 2015 by Richard J. Ruckman, MD T he complex surgery code was originally created for situations where extra work, supplies, or tech- niques were necessary for Xpand: New multiuse iris expander surgical device cataract surgery. In our area, the complex surgery code 66982 allows for approximately $150.00 more for the surgeon than the traditional cataract surgery code of 66984. It does not pay more to the ambulato- ry surgery center (ASC). Originally, it was thought that the 66982 com- plex surgery code would have very little use. However, with the advent of IFIS (intraoperative floppy iris syndrome), we find an increasing number of our cases are complex. Performing cataract surgery through a small pupil can be extremely difficult and requires additional surgical time. There have been a number of techniques used to address the small pupil. These included atropine drops preopera- tively, intracameral epinephrine, and dispersive viscoelastics. However, none of these address the surgical complexities in patients with IFIS. Mechanical devices address both issues: small pupil and floppy iris. Iris retractors have been a mainstay in expanding the pupil and have improved over the years but still require 4 additional paracentesis sites, which can be cumbersome to place, add to surgical time, and can leave the pupil irregular. In spite of these disadvantages, we find that the newer flexible iris retractors have become much easier to use and are very cost effective for our ASC. Malyugin rings have been a great leap forward in offering easier placement and removal. When used properly, the Malyugin rings general- ly leave the pupil with less damage than iris retractors. The problem has been the expense associated with a single-use device, which is not reim- bursed to the ASC. In our ASC, we had elected to use reusable flexible iris retractors for most of our complex surgeries. This allowed us to reduce our cost per case for iris expansion to approxi- mately $15.00. However, for the last 6 months, we have been able to use the Xpand, a newly released iris speculum de- vice by Diamatrix (The Woodlands, Texas). It functions similar to the Malyugin ring in terms of required incision size, placement on the iris, and expanded pupil size. The Xpand has one size, 6.7 mm, and is a tita- nium alloy device that is approved for multiple uses and resterilization up to 20 times. It makes our cost per case approximately $45. This is more than our iris retractors but about one-third the cost of the Malyugin ring. Our experience is that it is not only less expensive and easy to use but that it gives excellent centra- tion and visualization of the lens. The design and low profile make it The specialists in single-use. www.malosa.com • LASIK / LASEK / ReLEx / PRK • Phaco • Oculoplastics • IVT • Strabismus • Sub-Tenons ... "Malosa's single-use instruments and procedure packs provide optimal patient safety and brand new, flawless instruments for every eye." Prof. Dan Z Reinstein, MD MA(Cantab) FRCSC DABO FRCOphth FEBO - The London Vision Clinic • Brand new instruments, every time. • Zero cross-contamination risk. • Increased patient throughput. View our online brochure. Complete range of Instruments and Procedure Packs for all Ophthalmic specialties. Over 350 Instruments & 400 Packs for all specialties. continued on page 28