May 2019

CATARACT

Research highlight
Saving time with Omidria in FLACS cases


by Maxine Lipner EyeWorld Senior Contributing Writer


Capsule hooked by mechanical expansion of the pupil during FLACS
Source: Keith Walter, MD

 

Adding Omidria (phenylephrine/ketorolac, Omeros) to the irrigating solution during femtosecond laser-assisted cataract surgery (FLACS) can not only reduce the need for pupil expansion devices but can also lower surgical time, according to new study results1. Investigators found that mean surgical time was significantly reduced in cases using Omidria, 8.1 minutes compared with 9.4 minutes for those receiving epinephrine, reported Keith Walter, MD.
Often in femtosecond cases when the laser makes the capsulotomy within a few minutes, the pupil will decrease, creating difficulty. Before Omidria, the solutions were either to use a Malyugin ring to push it back open or hooks to keep it expanded. With the Malyugin ring, there’s concern that the pressure could cause a radial tear, and with hooks, an open capsule can be troubling because you don’t want to catch the edge of it, Dr. Walter said.

Less mechanical intervention

In the study, investigators examined 100 cases in which Omidria was used in the irrigating solution and a previous 100 consecutive eyes in which only epinephrine was used in the bottle, Dr. Walter said. All cataracts were removed by the same surgeon, with the same laser, and each patient received topical bromfenac 2 days before surgery.
Investigators found that with the Omidria patients, fewer of them needed Malyugin rings inserted during the cataract removal procedure. “Our incidence of Malyugin rings went from 12% to 2%,” Dr. Walter said, adding that while there were two cases in which rings were needed, Omidria was helpful in making the iris stiffer, resulting in less undulation during surgery.
There was also a significant reduction in surgical time with Omidria, which was assessed in two different ways. One was to look at all the cases in each group for a statistically significant difference in mean surgical time. “In the non-Omidria group, there were 12 Malyugin rings and of course it is going to increase the surgical time to put those rings in,” he said. “So we excluded those 12 eyes and the two from the Omidria group,” he said. Even so, investigators saw a statistically significant decrease in average surgical time between the two groups, with Omidria time at 8.1 minutes versus 9 minutes without.
Dr. Walter thinks that this gap remains because even if a ring is not inserted, time spent considering whether or not to do so can slow things down. “If you don’t use it and the pupil is still on the small side, you have to slow down when doing the surgery.”

Eyeing efficiency

The minute saved by using Omidria may translate into an ability to do more cases. “You’re saving 1 minute on a 7-minute case,” Dr. Walter said. For every seven cases practitioners are able to save 1 minute on, that’s another case they can do, he noted. If a high-volume surgeon normally does 14 cases in a day, they can now do 16 in the same time, with the same overhead costs.
For Dr. Walter, the take-home message is that for femtosecond cataract surgery, Omidria use is a more elegant solution to the problem of miosis, rather than a hook or a ring that could potentially cause damage. “If you want a premium outcome for your patients, I recommend a premium product like Omidria to keep the iris out of the way,” he concluded.

About the doctor

Keith Walter, MD

Professor of ophthalmology
Wake Forest University
Winston-Salem, North Carolina

Reference

1. Walter K, et al. Continuous intracameral phenylephrine-ketorolac irrigation for miosis prevention in femtosecond laser- assisted cataract surgery: Reduction in surgical time and iris manipulation. J Cataract Refract Surg. 2019;45:465–469.

Financial interests

Walter
: Omeros


 

Saving time with Omidria in FLACS cases Saving time with Omidria in FLACS cases
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