additional steroids or
antibiotics.
• And your surgeons
might have to insert a
three-piece IOL, which is less likely to expand the tear, instead of a
two-piece IOL.
All of those steps and additional supplies more than double the
duration of surgery and inflate your case costs, says Dr. Devgan,
stressing that you can't afford to waste minutes and dollars in a vol-
ume-driven specialty with razor-thin profit margins.
Fortunately, advanced phaco fluidics, femtosecond-lasers and
mydriasis-maintaining drugs can help prevent tears from occurring.
1. Room to move
Maintaining a pressurized and stable anterior chamber with balanced
fluidics lowers the risk of the posterior capsule coming up at the
phaco tip as the surgeon is removing parts of the lens nucleus, says
Jeffrey Whitman, MD, president and chief surgeon of the Key-Whitman
Eye Center in Dallas, Texas.
"Equalizing pressure in the eye means the anterior chamber is not as
deep, and risk of rupture is higher, but the patient will be more com-
fortable," says Dr. Whitman.
Newer phaco machines boast advanced fluidics, which give sur-
geons more exact control of how much fluid is introduced to the eye
than the traditional method of hanging a bottle of balanced salt solu-
tion above the patient and relying on gravity to maintain targeted
intraocular pressure. Surgeons can now set a target pressure that will
avoid creating a shallow anterior chamber while phaco machines
automatically deliver the fluid required to maintain that pressure —
even when phaco energy is applied, and during irrigation and aspira-
M A Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 9 1
You never know when something will go
wrong. That's what keeps me on my toes.
— Jeffrey Whitman, MD
