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1 3 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 6 Dropless surgery isn't the only new pharmaceutical that's simplifying ophthalmic sur- gery. Here are 3 new combination medications that make cataract and other refractive surgery easier, quicker and more efficient. • A simple pre-op drop regimen. Previously, nurses had to drown patients with drop after drop to numb the eye, dilate the pupil, and prevent post-op infections and inflammation before surgery, says Tracy A. Rhodes, RN, BSN, director of nursing at The Eye Center of North Florida in Panama City. Her center orders a "combo drop" from the center's compounding pharmacy. The combination drop includes an antibiot- ic, an anti-inflammatory, 2 dilating agents and a numbing agent. "Instead of a nurse having to put 3 to 4 drops in 3 times for each patient before surgery, you only do 1 drop," she says. • Better pupil dilation and pain control. Combination drugs also play a role in intraoperative solutions. T. Hunter Newsom, MD, founder of the Newsom Eye & Laser Center in Tampa, Fla., points to a new solution used during cataract surgery to enhance pupil dilation and ward off post-op inflammation and pain. The solution combines the dilator phenylephrine with the anti-inflammatory ketorolac, and is mixed with the doc's irrigation solution to provide a steady stream of the medications during surgery. While doctors have been adding pupil dilation drugs to irrigation solutions for years, Dr. Newsom notes that the new formula is the first combination that's FDA-approved specifically for this use. "We have been using epinephrine in our irrigating bottle to keep pupils dilated during surgery for a long time," says Dr. Newsom. "We also use NSAIDs pre-operatively for 3 days to help get patients dilated more and faster for cataract surgery." • An alternative to dropless surgery. Cataract patients who don't want dropless therapy — or whose surgeon doesn't perform the procedure — can receive a single combination drop that includes a steroid, an antibiotic and an anti-inflamma- tory (prednisolone acetate, moxifloxacin hydrochloride and ketorolac tromethamine, respectively), says Bret L. Fisher, MD, medical director of The Eye Center of North Florida. Those undergoing LASIK or photorefractive keratectomy receive a combi- nation of a steroid and an antibiotic. Patients are instructed to use the single drop 3 times a day for 1 to 3 weeks, depending on the surgery. Compared to standard post-op regimens, patients love the single drop's simplicity, he says. That's especially true since the center purchases and distributes the drops to patients as part of their surgery. For example, LASIK patients pay a bundled fee that includes the cost of the combination drop, which they then receive at the center once their surgery is complete. "That way we know they received the drops and that they know exactly how to use them," says Dr. Fisher. "It ends up helping us ensure compliance, and it works out great for our patients." — Kendal Gapinski OCULAR PHARMACEUTICALS 3 New Combination Drugs Simplifying Ophthalmic Surgery • STREAMLINED When it comes to new pharmaceuticals for ophthalmic procedures, simplicity is the name of the game. Pamela Bevelhymer, RN, BSN