Practice patterns of Canadian Ophthalmological Society members in cataract surgery: 2011 survey.

OBJECTIVE: To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery. DESIGN: Web-based questionnaire. PARTICIPANTS: Members of the COS indicating practice focus to be cataract surgery. METHODS: In January 2011 an e-mail with a link to Fluid Surveys was sent from the COS office to the 292 members who had indicated their practices' focus to be cataract surgery. A reminder e-mail was sent 3 weeks later. Approval for the survey was obtained from the Regina Qu'Appelle Health Region Research Ethics Board. All responses were collected anonymously. RESULTS: There were 92 responses (31.5%). In 2009, the response rate was 20.7%, and in 2010 it was 32.5%. The results of the 3 surveys were compared. There was a gradual increase in the use of topical-only anaesthesia, in the number of days during which the nonsteroidal anti-inflammatory drug (NSAID) eye drops were used preoperatively, and in the use of multifocal and toric intraocular lenses. Postoperatively, the use of an NSAID eye drop alone remained unchanged, but there was a decrease in the use of steroid eye drops alone and a corresponding increase in the use of a combination steroid and NSAID eye drop. CONCLUSIONS: Over the past 3 years the majority of the practice patterns in cataract surgery by the members of the Canadian Ophthalmological Society have remained unchanged. However, there were certain areas where definite trends were noted.

Practice patterns of Canadian Ophthalmological Society members in cataract surgery--2010 survey.

OBJECTIVE: To establish the cataract surgery practice patterns of the members of the Canadian Ophthalmological Society (COS). STUDY DESIGN: Web-based questionnaire. METHODS: In January 2010, an email with a link to SurveyMonkey was sent from the COS office to its 305 members who had indicated their practice focus is cataract surgery. A reminder email was sent 2 weeks later. All responses were collected anonymously. RESULTS: There was a 32.5% response rate (99 responses), compared with 20.7% in 2009. Two respondents volunteered that they no longer performed cataract surgery and 1 response was incomplete; therefore, 96 responses were analyzed. The results of the 2010 survey were compared to those of the 2009 survey. CONCLUSIONS: While the majority of the practice patterns analyzed were unchanged between the 2009 and 2010 surveys, there appears to be a trend to start nonsteroidal anti-inflammatory drug eye drops earlier preoperatively and an increase in the use of one-piece hydrophobic acrylic, aspheric, and blue-blocking intraocular lenses. The use of the fourth generation fluoroquinolone antibiotic gatifloxacin has increased at the expense of older antibiotics.

Practice patterns of Canadian Ophthalmological Society members in cataract surgery--2009 survey.

OBJECTIVE: To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery. DESIGN: A questionnaire consisting of multiple choice questions on cataract surgery practices was sent as an attachment by email to the members of the COS. PARTICIPANTS: Seven-hundred and seventy-seven COS members with a valid email address in the Society's database. METHODS: A 29-item questionnaire pertaining to cataract surgery practices was sent by email. A reminder email with the attached questionnaire was sent 3 weeks later. The survey data were descriptively analyzed with the Statistical Package for the Social Sciences (SPSS) v 16.0 software and the results compared with those from surveys by the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. RESULTS: There were 161 responses. Of these, 30 members did not do any cataract surgery, and a further 8 responses were incomplete, therefore, 123 responses were analyzed. The majority of the respondents (69.1%) were between 40-59 years old. Phacoemulsification was the procedure of choice of all the respondents. Topical anaesthesia with clear corneal incisions was the most popular technique. Only 59.8% of respondents used a NSAID drop while 90.1% used a steroid drop postoperatively. CONCLUSIONS: The practice patterns of the members of the COS for cataract surgery have not been reported before. This survey will serve as a baseline for future ones.

Pupil size with and without adrenaline with diclofenac use before cataract surgery.

PURPOSE: To determine whether adrenaline in the irrigating solution is necessary when diclofenac eyedrops are used before cataract surgery. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: In this prospective randomized masked study, all patients used diclofenac eyedrops 2 days preoperatively. The pupils were dilated with a wick soaked in a dilating solution containing diclofenac. Patients were divided into 2 groups. One group had 0.5 mL of 1:1000 adrenaline in 500.0 mL of fortified balanced salt solution (BSS Plus) (adrenaline group). The other group did not (no-adrenaline group). The horizontal diameter of the pupils was measured with calipers. RESULTS: The study included 207 patients. There were no surgical complications. In the adrenaline group, the mean pupil size was 8.19 mm +/- 0.86 (SD) before the first incision, 8.14 +/- 0.87 mm after phacoemulsification, and 8.14 +/- 0.85 mm after cortical removal. In the no-adrenaline group, the means were 8.19 +/- 0.87 mm, 7.94 +/- 0.99 mm, and 7.87 +/-1.03 mm, respectively. The mean pupil constriction was 0.05 +/- 0.21 mm in the adrenaline group and 0.33 +/- 0.43 mm in the no-adrenaline group. The difference was statistically significant (Mann-Whitney test). Further analysis of preoperative pupil size showed a significant difference for smaller pupils only. CONCLUSIONS: When diclofenac eyedrops were used before cataract surgery, the smaller preoperative pupils constricted significantly less when adrenaline was added to the irrigating solution. This was not true for larger pupils. Thus, adrenaline in the irrigating solution does not appear necessary in eyes with large preoperative pupils.

Aqueous humor penetration of gatifloxacin and moxifloxacin eyedrops given in different concentrations in a wick before cataract surgery.

PURPOSE: To determine whether the penetration into the aqueous humor of gatifloxacin (Zymar) and moxifloxacin (Vigamox) eyedrops was affected by altering their concentrations in the dilating mixture in which the wick used to dilate the pupil before cataract surgery was soaked. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: This prospective randomized open-label study comprised 65 women and 35 men who were divided into 2 main groups. One group received 1 mL of the antibiotic in the dilating mixture and the other, 2 mL. Each group was divided into 2 subgroups, 1 for gatifloxacin and 1 for moxifloxacin. At the beginning of surgery, 0.1 mL of aqueous humor was aspirated, frozen, and couriered to the provincial laboratory for analysis by high-performance liquid chromatography. RESULTS: In the first group, the mean concentration of gatifloxacin in the aqueous humor was 0.30 microg/mL +/- 0.21 (SD) and of moxifloxacin, 0.97 +/- 0.63 microg/mL. When the volume of the antibiotic in the dilating mixture was doubled, the mean concentration increased to 0.34 +/- 0.25 microg/mL and 1.37 +/- 0.79 microg/mL, respectively. Only the increased penetration of moxifloxacin was statistically significant. CONCLUSIONS: Moxifloxacin penetrated the aqueous humor better than gatifloxacin when given in a wick soaked in the dilating mixture before cataract surgery. Only the penetration of moxifloxacin increased significantly when the volume of the antibiotic in the dilating mixture was doubled. In both groups, only moxifloxacin reached and exceeded the minimum inhibitory concentration levels for the most common ocular pathogens causing endophthalmitis.

Aqueous humor penetration of gatifloxacin and moxifloxacin eyedrops given by different methods before cataract surgery.

PURPOSE: To determine whether the penetration into the aqueous humor of 2 new fourth-generation fluoroquinolone antibiotics, gatifloxacin (Zymar) and moxifloxacin (Vigamox) eyedrops, was affected by different methods of administration before cataract surgery. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: This prospective randomized study comprised 193 patients. The patients were divided into 2 main groups. One group received gatifloxacin eyedrops and the other, moxifloxacin eyedrops. Each group was subdivided into 4 subgroups. All patients received the drops 4 times a day starting 2 days preoperatively. The first subgroup did not receive any more antibiotics. The second subgroup received the antibiotic drops 3 times, starting approximately 2 hours preoperatively. The third subgroup received a wick soaked in a dilating mixture containing the antibiotic. The fourth subgroup received the wick and the antibiotic drops at the time of preparation for surgery. At the beginning of surgery, 0.1 mL of aqueous humor was aspirated, frozen, and sent under ice by courier to the Provincial Laboratory for analysis by high-performance liquid chromatography. RESULTS: The study included 124 women and 69 men. The mean concentrations in the aqueous humor were 0.19, 0.82, 0.22, and 0.30 microg/mL in the 4 gatifloxacin subgroups, respectively, and 0.38, 2.16, 0.88, and 0.97 microg/mL in the 4 moxifloxacin subgroups, respectively. Analysis of variance showed the differences between the 2 antibiotics to be statistically significant. CONCLUSIONS: Moxifloxacin penetrated the aqueous humor better than gatifloxacin regardless of the method of administration. Both antibiotics penetrated the aqueous humor well when given in drop form. They reached and exceeded the minimum inhibitory concentration levels for the most common ocular pathogens causing endophthalmitis. Only moxifloxacin reached these levels when the wick was used.

Perioperative use of warfarin and aspirin in cataract surgery by Canadian Society of Cataract and Refractive Surgery members: survey.

PURPOSE: To survey the members of the Canadian Society of Cataract and Refractive Surgery (CSCRS) and identify their practices regarding the perioperative use of warfarin and acetylsalicylic acid (aspirin) in cataract surgery. SETTING: Private practice, Regina, Saskatchewan, Canada. METHODS: Members of the CSCRS were faxed a questionnaire that examined their perioperative management of patients being treated with warfarin and aspirin. RESULTS: Of the 110 eligible participants, 82 returned a completed questionnaire, representing a response rate of 74.5%. Warfarin or aspirin was routinely stopped prior to cataract surgery by 25.6% of the respondents. The majority of surgeons who discontinued these medications reported doing so 3 to 7 days prior to surgery and resumed their use 1 to 2 days postoperatively. Topical anesthesia and clear corneal incisions were preferred by the higher volume surgeons. These surgeons were also less likely to discontinue either warfarin or aspirin preoperatively. CONCLUSIONS: The majority of the Canadian Society of Cataract and Refractive Surgery members do not stop either warfarin or aspirin for cataract surgery during the perioperative period.

Use of a wick to deliver preoperative mydriatics for cataract surgery.

Before cataract surgery at our institution, we traditionally dilated the pupils with 5 drops: proparacaine 0.5%, cyclopentolate 1%, phenylephrine 2.5%, flurbiprofen sodium 0.03% (Ocufen), and ofloxacin 0.3% (Ocuflox) at 15-minute intervals given 3 times. This was work intensive for the nursing staff. Since September 2000, we have used a wick soaked in a dilating mixture containing cyclopentolate 1%, phenylephrine 2.5%, diclofenac sodium 0.1% (Voltaren), and Ocuflox. Use of the wick has been beneficial and time saving to hospital staff.