be the tab for the new drug and will insurers reimburse it? Failing
that, will patients be allowed to pay? Second, clinical concerns. Ms.
Schneeweiss-Keene asks, What about patients who are steroid respon-
ders? And is it dangerous to inject drugs into the posterior chamber?
"Our retina surgeon is opposed to the routine installation of medica-
tions into the posterior chamber and our anterior surgeons cooperate
with his suggestions," says Mr. Lenz.
Pupillary dilation and maintenance
How are facilities handling floppy iris syndrome and miotic pupils?
Our survey found that 48% say their surgeons typically use a mechani-
cal pupil expansion device and 16% use a compounded pharmaceuti-
cal like Shugarcaine. Meanwhile, 5% use the FDA-approved ketorolac
phenylephrine compound Omidria. That drug might be more popular,
A U G U S T 2 0 1 8 • O U T PA T I E N T S U R G E R Y. N E T • 9 7
maceuticals and quality and safety." Others said that ethical 503B
compounding pharmacies produce excellent products — often at
a lower price.
• Intracameral antibiotics. Of the facilities surveyed, 42% use
intracameral antibiotics during cataract surgery. Once, van-
comycin was the standard, but a recent study linked that drug to
retinal vasculitis in a small number of patients. Two-thirds of
facilities that use intracameral antibiotics now use self-preserved
moxifloxacin (Vigamox), 20% use cefuroxime and 19% use van-
comycin. One reports using gentamycin and another reports using
ciprofloxacin.
• Outsourcing. About 10% of facilities use an outsourcing service,
about the same as last year. Almost 60% of those who do are
"very satisfied."
