Most respondents, however, brought
up several reasons why they don't use
it, and they go beyond the higher per-
case cost. "With the older population,
you never know the effect after dis-
charge," says Nancy Haskell, RN,
CNOR, CRNO, director of nursing at
Capitol City Surgery Center in
Sacramento, Calif.
"We did use it, but the timing of
onset is hard to manage with such fast
cases," says Carson McCafferty, MSN,
clinical director at Eye 35 Ambulatory
Surgery Center in Schertz, Texas.
"We've gone back to using IV midazo-
lam and fentanyl."
A nurse manager at a Florida surgery
center reports, "We currently prefer to
start an IV via saline lock for emergency
access due to the age and health status
of our patients." Another respondent who's consid-
ering shifting cataract cases to an office-based set-
ting says oral sedation might be a safe alternative to
IV sedation in healthy, younger patients.
• Dropless surgery. Post-op drop compliance is
a perennial problem with cataract patients, mean-
ing so-called "dropless" cataract surgeries are an
attractive option. Use of dropless techniques rose
from 31% in our 2018 survey to 45% this year. One
respondent reports performing "less-drops sur-
gery," which involves injecting medications intra-
camerally, and still having patients use drops
post-operatively.
Russell Snook, MD, of Eye Surgery Center of
North Dallas in Carrollton, Texas, reports that he
doesn't use dropless techniques yet because of both
the higher cost and the lack of an available FDA-
approved product.
• Intracameral antibiotics. Nearly 45% of respon-
dents say their surgeons are using intracameral
antibiotics during surgery. At 60%, moxifloxacin is
the most frequently used agent among centers that
have embraced the approach.
• MIGS. Micro-invasive glaucoma surgeries
remain popular, with 71% of
respondents saying their centers
perform the procedure. Among
those centers, stent implantation
was the most common method
(92%), followed by goniotomy/tra-
beculotomy (67%).
The impact
of the pandemic
Facility administrators say the
COVID-19 pandemic has resulted
in decreased case volumes, tem-
porary closures and protocol
A U G U S T 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 3 9
GET INSIDE Almost half of the survey's respondents embrace the use of intracameral antibiotics.
We asked administrators about the pandemic's impact on how
safe patients and staff feel about visiting or working at oph-
thalmic surgery centers. In general, patients and staff
expressed the same moderate level of concern.
Patients Staff
Very fearful 0% 2%
Somewhat fearful 36% 34%
Neutral/not an issue 28% 21%
Concerned, but willing to come in 32% 32%
Not fearful 4% 11%
The COVID-19 Fear Factor
