Eyeworld

EW CATARACT 75 January 2017 by Liz Hillman EyeWorld Staff Writer Should surgeons still be trained and maintain skills in these procedures despite the prevalence of phacoemulsification? M anual small inci- sion cataract surgery (MSICS) has been touted as an ideal technique in develop- ing countries where phacoemulsifi- cation equipment is expensive and not readily available. What's more, a phaco procedure may not be the safest option for the type of cataracts ophthalmologists in these countries regularly encounter. 1 But does MSICS and other extra- capsular cataract extraction (ECCE) techniques have a place in devel- oped countries where phaco is avail- able, affordable, and the well-estab- lished gold standard? Is it something that should be taught in training? Is it a skill to be maintained? Luis de la O, MD, Torreón, Mexico, thinks so. It's an important skill to learn and maintain if you are trying to be a versatile anterior segment surgeon, he said. Dr. de la O explained how MSICS and ECCE in the developed world Dr. Chang said he would expect that intracameral vancomycin use has dropped since that time. Among other observations, Dr. Chang noted the continued drop in intraocular antibiotics being admin- istered through the irrigating bottle. Prior ASCRS surveys showed that of those surgeons employing intraocu- lar antibiotic prophylaxis, 48% used the irrigating bottle in 2007 com- pared to only 16% in 2014, and 18% in the current survey. Francis Mah, MD, Scripps Clinic, La Jolla, California, said the results of the survey, overall, were what he would have expected, but he was "pleasantly surprised" to see a larger number of respondents using intracameral antibiotics. "I was happy that the medical literature has swayed a lot of people into intracamerals. I thought it would have been a lower number," he said. Dr. Henderson said based on these numbers, "intracameral anti- biotics appear to be becoming the standard of care in the U.S." Dr. Shorstein said the uptick of this practice "points out the need to continue pursuit of an FDA-ap- proved drug." The Research Council is de- signing a trial that "will definitively show the benefit of antibiotic pro- phylaxis, and we're looking at both topical vehicle delivery systems and intraocular," Dr. Rhee said. Dr. Mah thinks this is an im- portant issue to research as well. "There is not in the United States an FDA-approved, commer- cially available medication, regard- less of if it's drops or intracameral, that's approved for prophylaxis of endophthalmitis or post-cataract surgery infections," Dr. Mah said. "I think U.S. surgeons deserve a medication or at least some proof to support the use of these medica- tions." EW References 1. Chang DF, et al. Prophylaxis of postopera- tive endophthalmitis after cataract surgery: results of the 2007 ASCRS member survey. J Cataract Refract Surg. 2007;33:1801–5. 2. Chang DF, et al. Antibiotic prophylaxis of postoperative endophthalmitis after cata- ract surgery: Results of the 2014 ASCRS member survey. J Cataract Refract Surg. 2015;41:1300–5. Editors' note: Dr. Mah has financial interests with Bausch + Lomb (Bridge- water, New Jersey), Alcon (Fort Worth, Texas), and Allergan (Dublin, Ireland). Drs. Chang, Henderson, Rhee, and Shorstein have no financial interests related to their comments. Contact information Chang: dceye@earthlink.net Henderson: bahenderson@eyeboston.com Mah: Mah.Francis@scrippshealth.org Rhee: dougrhee@aol.com Shorstein: nshorstein@eyeonsight.com continued on page 78 Dr. de la O and his daughter, Stephanie de la O, MD, perform MSICS. Source: Luis de la O, MD Experts continued from page 74

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