JCRS March 2021
Innovative 3D visualisation systems could offer an increased margin of safety by reducing microscope light-induced retinal phototoxicity in patients undergoing ophthalmic surgery, a new study suggests. The retrospective study compared outcomes for conventional and 3D visualisation surgery (Alcon’s NGENUITY 3D Visualization System) in 51 eyes undergoing femtosecond laser-assisted cataract surgery. While light exposure was similar in both groups, the intensity of light used in the 3D group was significantly less. The 3D group was significantly more likely to reach a visual acuity one day after surgery that was within two lines of that seen at one month. Digital visualisation systems also offer the advantage that images derived from the analogue microscope and displayed on the 3D flat panel screen can be digitally enhanced, thus allowing for the use of lower illumination levels yet with comparable visualisation.
ED Rosenberg et al., “Efficacy of 3D digital visualization in minimizing coaxial illumination and phototoxic potential in cataract surgery: pilot study”, 47(3):291-296.
COST EFFICACY AND PREMED
While the ECRS PREMED (PREvention of Macular EDema after cataract surgery) study has shown that a combination of topical NSAIDs and corticosteroids is most effective in reducing the incidence of CME after cataract surgery compared with either drug alone, cost efficacy data has until now been unavailable. A prospective analysis of the ESCRS PREMED data looked at cost-effectiveness through quality-adjusted life years (QALYs). The study concluded that combination treatment with topical bromfenac and dexamethasone was cost-effective in prevention of CME in patients without diabetes compared with treatment with either drug alone. Assuming a cost of € 20,000 per QALY, cost effectiveness probability was 3%, 32% and 65% for bromfenac, dexamethasone, and combination groups respectively.
R Simons et al., “Economic evaluation of prevention of cystoid macular oedema after cataract surgery in patients without diabetes: ESCRS PREMED study report 4”, 47(3):331-339.
COSTS OF COVID
The interruption in elective ophthalmic surgeries at hospital outpatient departments seen during COVID-19 pandemic led to hundreds of millions of dollars in lost income per month for US hospitals. The cessation in elective surgeries also reduced opportunities for trainees at academic medical centres. Researchers reached these conclusions by comparing national hospital statistics from before (2017) and after the pandemic. The analysis showed that cataract, strabismus and keratoplasty were performed more often in teaching hospitals than in non-teaching hospitals, indicating an effect on the surgical training of residents and fellows. The study results are probably an underestimate, since the analysis did not include all elective procedures such as glaucoma and oculoplastic surgery.
MJ Fliotsos et al., “Impact of reduced elective ophthalmic surgical volume on U.S. hospitals during the early coronavirus disease 2019 pandemic”, 47(3):345-351
