Outpatient Surgery Magazine

Surgical Smoke Nearly Killed Me - Subscribe to Outpatient Surgery Magazine - February 2018

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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ications and in as much as 25% of the general patient population, says Steven Silverstein, MD, FASC, an ophthalmic surgeon in Kansas City, Mo. Plus, there are plenty of patients whose pupils don't dilate fully or don't dilate to the extent that they did during pre-op clinic visits. Maintaining pupillary dilation improves access to the eye and visuali- zation of delicate anatomy, factors that decrease risk of posterior cap- sular tears, zonular damage and vitreous loss, and make cataract removal easier and safer. It also lets surgeons perform complex cases more efficiently. Surgeons have plenty of available options to keep pupils dilated during surgery, from hooks and rings to pharmaceutical agents. The optimal choice for your facility demands striking a balance between cost and clinical efficacy. • Iris hooks. Reusable iris hooks don't add to case costs, but the ini- tial capital expenditure will run your facility a couple hundred dollars. A small stab incision is made in the limbus, through which surgeons insert 4 hooks to maintain pupil dilation. In patients with IFIS, the iris tends to prolapse out of the wound, which can be prevented by plac- ing the hooks in a diamond configuration underneath the main tempo- ral incision, says ophthalmic surgeon Nick Mamalis, MD, co-director of the Intermountain Ocular Research Center in Salt Lake City, Utah. • Iris rings. Single-use rings cost approximately $125 and reusable options run approximately $50 per use. Surgeons insert ring-type devices through a clear corneal incision to create and maintain pupil dilation. There are several models available that are largely effective in giving surgeons the space they need to operate. Surgeons must decide which design and delivery method — a circular or square dila- tion and inserter or separate injector — works best in their hands. During surgery, surgeons must be aware of the ring's position on the pupil, so they don't dislodge the device when sliding instruments into and out of the eye. F E B R U A R U Y 2 0 1 8 • O U T PA T I E N TS U R G E R Y. N E T • 1 0 1

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