Eyeworld

EW CATARACT 81 April 2017 "We would have a very dif- ficult time getting approvals for office-based cataract surgery," Dr. Srikumaran said. "The actual room, equipment, and appropriate main- tenance of the operating space to ensure patient safety is a big under- taking, and I don't see how we could manage that in our offices. We have had a big push to try to consolidate our cases into the ASC rather than hospital for routines cases in an effort to reduce costs." Dr. Srikumaran noted that her organization performs many proce- dures, such as refractive and corneal crosslinking, outside a conventional operating room (OR), but these are not intraocular procedures. "Also, many of the patients we are doing cataract surgery on are not as healthy, so careful patient selec- tion would be key, and I would be hesitant unless the office procedures are comparable to that of an ASC," Dr. Srikumaran said. Dropless cataract surgery Surgeons generally view the newer surgical approach known as dropless cataract surgery as unrelated to the issue of office-based cataract surgery. "The dropless protocol only reduces or eliminates the post-op drops," said Dr. Devgan. "The 'no IV' cataract surgery is possible with oral or sublingual medications but the delivery is not as consistent when compared to an IV, the ability to have a quick effect." Dr. Devgan noted that IV deliv- ery is effective within a minute or less, while oral medications need 15 to 60 minutes to take effect. "With an IV, other medica- tions can be given for pain (such as alfentanil or fentanyl) and reversal agents such as flumazenil (to reverse the benzodiazepine effects) are also available," Dr. Devgan said. "Not so with the oral 'no IV' medications." Others agreed. "I don't think dropless cataract surgery makes office-based cataract surgery more or less appealing," Dr. Berdahl said. "I really believe in intracameral antibiotics and re- treatment and the need for drops— perhaps sublingual anesthesia options—would make office-based cataract surgery more appealing, but I still like the oversight of anesthesia professionals in combination with my cataracts." EW References 1. Ianchuley T, et al., Office-based cataract surgery, Ophthalmology. 2016;123:723–8. Editors' note: The physicians inter- viewed have no financial interests related to their comments. Contact information Berdahl: john.berdahl@vancethompsonvision. com Chiu: cchiumd@gmail.com Devgan: devgan@gmail.com A safe and effective solution for intraoperative small pupil expansion • Gentle on iris and other intraocular tissue • Iris quickly returns to natural shape post surgery • Easy insertion and removal Eric Donnenfeld, MD Ophthalmic Consultants of Long Island, NY "I particularly like the I-Ring because I fi nd it does not distort the pupil or tear the sphincter." Visitec ® I-Ring ® Pupil Expander A complete portfolio of ophthalmic products 1-866-906-8080 beaver-visitec.com ASCRS Booth 2613

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