Pupil maintenance
When it comes to opening up a tough pupil, most surgeons' first
instinct is to turn to pharmaceutical options, says Dr. Newsom. "The
easiest thing is to use eye drops before surgery," he says. "Then, if the
pupil still won't open up, in surgery you can use an intracameral injec-
tion."
While Shugarcaine, a compounded solution of epinephrine and lido-
caine, has traditionally been a popular injection choice, there's a new
option on the market called Omidria, a phenylephrine and ketorolac
injection that is added to the standard irrigation solution used during
cataract surgery. The manufacturer of Omidria claims it keeps the
pupil open without needing additional mechanical methods, like
Malyugin rings, which it says can increase complication rates.
While patients who receive Malyugin rings versus pharmaceutical
dilation systems may have a higher complication rate, Dr. Newsom
says this is because these patients are at an overall higher risk. "I
always say, if the pupil is not dilating normally, it's not a normal eye,"
he adds.
Reprocessing tools
One of the key aspects of safe cataract surgery is thorough repro-
cessing. At Ms. Radke's center, staff take advantage of ultrasonic wash-
ers, which help ensure that delicate instruments like diamond knives are
thoroughly cleaned after each case. Ms. Radke also looked into lumen-
flushing devices, which automatically push pressurized water through
tiny lumens to better remove bioburden from phaco handpieces, needles
and other ports.
Ergonomics
Surgeons bent over microscopes day in and day out can develop
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