FREMONT, CA:Surgery centers must take on a variety of factors, ranging from clinical and financial benefit to the impact on practice flow and logistics when deciding on whether to introduce new surgical techniques. In one such example, the pros and cons of various mydriasis approaches were evaluated during cataract surgery by administrators and surgeons. Keeping the tone and the size of the pupil and therefore a proper view of the operative field is important during the entire procedure to reduce the risk of capsules, vitreous loss, iris damage, and other possible operating problems. Challenges exist, as the surgeon seeks to achieve this goal, including a rising number of patients who have a history of systemic medications (known and unknown) that contribute IFIS and unpredictable dilation.
During surgery, preoperatively administered topical agents may be washed out and reduced. Although many surgeons have figured it effective to add or to deliver drug such as compounded epinephrine or phenylephrine during the course of surgery, the new standards for ambulatory surgery centers (ASC) in 2009 increased their scrutiny of these off-label practices. For continuous intracameral administration during cataract surgery, a combination of phenylephrine/ketorolac had been approved several years ago to lower the after operative pain and prevent pupil miosis.
Over one-third of patients with cataract surgery experience moderate to severe pain during their immediate post-operative period, and research has demonstrated that post-operative pain is undoubtedly a leading cause for unrest. In clinical trials, patients with a combination of fixed doses were more than 50 percent more likely to be pain-free. As a consequence, on the day of surgery with phenylephrine/ketorolac significantly fewer patients needed pain medicines, including opioids. New technologies can make practices more consistent between cases. The stability of iris can be removed entirely and the operating flow better anticipated, which increases efficiency by using phenylephrine/ketorolac.