Eyeworld

EW CATARACT 35 June 2016 Only the HOLOS IntraOp ™ Wavefront Aberrometer continuously streams patient refractive data. Meaning you'll get a non-stop look at your procedure as it changes. And see cataract surgery in a whole new light. With HOLOS, precision doesn't pause —and neither will you. Really real time. ©2016 Clarity Medical Systems Inc. PN 100331 Rev A 04/16 HOLOS.com IOL Predictor Coming Summer 2016 Editors' note: Dr. Arshinoff has no financial interests related to his com- ments. Dr. Mah has financial interests and the patient ended up with iris atrophy. While this was 1 rare case, some concern comes from high- dose systemic administration of moxifloxacin, which can lead to a syndrome of bilateral acute iris tran- sillumination. He added that this, too, is rare and thought to be related to very high concentrations of the moxifloxacin transiting the iris or being in the vitreous but not in the anterior chamber. To help avoid endophthalmitis with these intracameral agents, Dr. Arshinoff recommended changing the volume injected. "Why does ev- eryone inject 0.1 cc into the anterior chamber of the eye?" he asked, add- ing that it's done this way because that's what will fit in the small area of the vitreous when treating cases of endophthalmitis. "Why would we inject 0.1 cc into an anterior chamber when what we want to do is exchange the fluid in the anterior chamber or wash it out?" It would be easier to accurately inject 0.3 cc, with the concentration appropriate- ly adjusted, he thinks. When it comes to the concen- tration, this may also need some rethinking. While Vigamox may work well for intracameral use right out of the bottle, rather than taking the risk of a problem from a high concentration, Dr. Arshinoff recom- mends diluting this in balanced salt solution so that you can be sure the solution is isotonic, pH balanced, and safe, and then injecting more of it. Overall, Dr. Arshinoff is con- vinced that American physicians will gradually begin using more in- tracameral drugs to prevent endoph- thalmitis. As physicians around the world get lower infection rates and American physicians lag behind, pa- tients who do get endophthalmitis will ask why their physician didn't use intracameral antibiotics to help stave this off, and some may even sue. EW Reference 1. Endophthalmitis Study Group, European Society of Cataract & Refractive Surgeons. Prophylaxis of postoperative endophthalmitis following cataract surgery: results of the ESCRS multicenter study and identification of risk factors. J Cataract Refract Surg. 2007;33:978–88. with Alcon, Allergan (Dublin), Bausch + Lomb (Bridgewater, New Jersey), and PolyActiva (Melbourne, Australia). Contact information Arshinoff: ifix2is@gmail.com Mah: mah.francis@scrippshealth.org

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