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COVER STORY


Clinical Trends in ASC Ophthalmology


‘Dropless’ approach, bi-lateral, same-day sequential cataract surgery and Zepto system are improving the quality of eye surgery BY ROBERT KURTZ


O


phthalmology procedures con- tinue to migrate out of hospi-


tals and into ASCs, thanks to new clinical developments. “Ophthalmology engagement and


ownership in ASCs is growing,” says Richard Lindstrom, MD, who performs ophthalmic procedures at Minnesota Eye Consultants’ ASC in Minnetonka, Minnesota. “This comes as no surprise as there are now few patients not appro- priate for outpatient ophthalmic surgery.” Patients at Blake Woods Medical


Park Surgery Center in Jackson, Mich- igan, receive exceptional care often at a much lower cost, says Mellissa Mitch- ell, RN, CASC, clinical director of


12 ASC FOCUS AUGUST 2019| ascfocus.org


nursing at the ASC. “That means hap- pier patients and happier surgeons.”


Movement Toward ‘Dropless’ Cataracts Traditionally, cataract surgery has involved the use of multiple medica- tions administered over a prolonged period, says Eric Donnenfeld, MD, of Island Eye Surgicenter in Carle Place, New York. Surgeons use antibiotics to reduce endophthalmitis risk, cortico- steroids to reduce inflammation and non-steroidals to prevent cystoid mac- ular edema and pain. “Many doctors use these medications preoperatively and then continue them postopera- tively,” he says. “The challenge is that


patients may be required to administer these drops for a long time.” In a worst-case scenario, Don- nenfeld says, patients will need to administer 12 drops a day for almost a month. This can be difficult for senior citizen patients because they need to remember to use the medications and might not have the mental and physical dexterity required to administer them properly. “The good news is that sur- geons now have the option to transition from postoperative drops to intraoper- ative medication delivery.” One such example, Donnenfeld says, is an intracameral corticosteroid deliv- ery system in which the physician, upon completion of cataract surgery, injects a small delivery of dexamethasone inside the eye that dissolves over a period of a few weeks. “It reduces inflam- mation effectively and is essentially the equivalent of using prednisolone


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