Want to give your ophthalmology docs their holiday presents early this year? Check out these three new products that were generating buzz at the American Academy of Ophthalmology annual meeting in Chicago last month. You might like what you see.
Another topical option
Tetravisc, a long-lasting, high-viscosity topical anesthetic from Cynacon/Ocusoft, comes in 5ml ophthalmic dropper bottles. The company says Tetravisc provides a longer anesthetization time than other traditional ophthalmic solutions and significantly improves pain levels in post-operative patients thanks to its rapid dispersion across the cornea and a controlled tip drop.
We recently started using Tetravisc. One of my facility's cataract surgeons uses topical anesthesia exclusively. Before Tetravisc, you had to put several liquid numbing drops into the eye, which wears on the cornea, or you would squirt Xylocaine gel (our formerly preferred method), which stays in longer and works well.
The problem with the gel, however, is that it is very thick and difficult to administer. First of all, you can't risk contaminating the whole tube by squirting the gel directly into the eye. But dividing the tube's contents into syringes is time-consuming, plus the syringes are an added expense. Once it is in the eye, Xylocaine gel is so thick, it's goopy when the doc opens the eye - which most surgeons don't like.
We like Tetravisc because it is slightly viscous - enough so to stay in the eye, but not get in the surgeon's way - and comes in an easy-to-administer bottle. And you don't need to use much to gain the desired effects.
We pay $14.95 for a 5ml bottle of Tetravisc. When we price-compare that to using the Xylocaine gel tube ($20), then factor in our having to transfer it to a syringe with a catheter, we save money on delivery, too.
Reduced stack height on microscopes
If your docs would like improved ergonomics on your surgical ophthalmic microscope, Carl Zeiss's Invertube may present a solution.
The Invertube eliminates the need for external inverters, which until now have been required for use with indirect fundus viewing systems, because an inverter is integrated into the binocular tube. This not only reduces the stack height of the surgical microscope, but also lets surgeons sit in a comfortable, upright position. Even though individual procedures might take just minutes, over the course of a day surgeons spend long hours performing intricate procedures while looking through the microscope, causing back and neck strain to build.
I think this will be especially useful for retinal surgery because those procedures take longer. In addition, first-time retinal surgeons using the Invertube will be able to view the exact image - instead of having to mentally convert the mirror image when they look in the scope - and that will definitely reduce the learning curve for them.
The Invertube can be retrofitted on the OPMI line of scopes from Carl Zeiss. It's also available for the assistant's microscope on the VISU 200 and the VISU 210. The company would not give a price.
A viscoelastic for the whole procedure?
Alcon is marketing Discovisc (a sterile solution of highly purified, non-inflammatory sodium chondroitin sulfate and sodium hyaluronate) as a viscous-dispersive viscoelastic; it exhibits the best characteristics of both higher-viscosity cohesives and lower-viscosity dispersives, says the company. The result, according to Alcon, is that the viscoelastic is designed to take the surgeon from start to finish without having to change viscoelastic halfway through a cataract procedure. It comes in single, 1ml latex-free syringes.
The top features, according to the company:
- space maintenance,
- clarity for maximum visualization,
- low elasticity to help control the anterior capsule flap and reduce lens skiing,
- enhanced endothelial protection,
- retention at various flow rates, and
- long molecular chain for easier removal.
My facility's surgeons haven't tried Discovisc yet, but it sounds promising. The results of the FDA phase III clinical trial show it performs similarly to the Healon cohesive product (1% sodium hyaluronate), from AMO, with regard to pressure spikes and endothelial cell loss. The trial included 249 patients undergoing cataract extraction with IOL implantation; patients were randomly assigned to Discovisc or Healon. No patients experienced IOP rise over 30mm Hg at 30 and 90 days. At six hours, about 13 percent of patients in both groups had pressure spikes; at one day, 6 percent had elevated pressures; and at one week, zero Discovisc and 1 percent of Healon patients did.
Alcon would not release pricing.
Bigger, stronger, more visible prep
With its new ChloraPrep 26ml, Mediflex has introduced the only 2% chlorhexidine gluconate and 70% isopropyl alcohol surgical prep that is FDA-approved and meets CDC guidelines for the preferred amount of CHG.
Designed specifically for use within the surgical suite, it combines the CDC recommended percentage of CHG with IPA for immediate and long-lasting bactericidal properties, says the company. Clinical evidence demonstrates that the combination of 2% CHG and 70% IPA possesses superior immediate, residual and cumulative antibacterial activity than the current standard, iodophors, and other commonly used antiseptics such as alcohol. While alcohol kills 99.99 percent of bacteria in 30 seconds, CHG continues to kill bacteria for a minimum of 48 hours. The new ChloraPrep's dual action is the key to reducing infection-causing bacteria on the skin.
In addition, Mediflex says it has enhanced the effectiveness of delivery. Because it is a one-step skin prep, ChloraPrep can save you pre-op time. The applicator keeps the hands away from the prep site and provides a friction scrub. The new, larger size means you won't have to open two in the operating room for cases that need larger areas of the body prepped. And the patented Scrub Teal tinting translates to better visualization of the prepped area.
Unlike iodophors, the most commonly used skin preps, the antibacterial properties of ChloraPrep are not neutralized in the presence of organic matter such as blood and serum. Furthermore, the product is said to be less irritating to the skin than iodophors. The company would not give a price.
For more information, visit writeOutLink("www.chloraprep.com",1) call (800) 523-0502 or circle number 167 on your Reader Service Card.
Suturing without the needlesticks
Blunted suture needles have yet to catch on, but now there's a new option: the 360? Fascia Closure Device from SuturTek, the first and only device to "aid in the prevention of suture needlestick injuries," according to the FDA-approved label claim. Suture needlestick injuries are the second leading cause of sharps injuries (occurring in 15 percent of all procedures) and fascia closure is the most common suture needle injury (59 percent of them).
This 360? Fascia Closure Device isolates the sharp point of the suture needle entirely within a sterile, disposable cartridge during loading, handling, suturing and unloading. First, you pop the cartridge, which comes pre-loaded with needle and suture, onto the device. From there, it's as simple as stapling, the company says; all you need to do is squeeze the handle twice (once to drive the needle, once to thread) to place a stitch. The needle will always follow the arc of its own curve, letting the surgeon retain control of the placement, depth and spacing of each stitch. And, the company says, it's faster than suturing by hand.
Because the needle is enclosed, no one is at risk for a needlestick when the device is passed. The device eliminates the need for pick-ups and needle holders, and the handle is ergonomically designed for equal facility in either hand, says SuturTek. The device is reusable and lists for $1,500. Cartridges are $25 each; about two cartridges are needed to perform a midline closure.
For more information, visit writeOutLink("www.suturtek.com",1), call (866) 839-0186 or circle number 168 on your Reader Service Card.
Wear and gel
A personal hand-gel dispenser that attaches to your waistband may help increase compliance with hand hygiene protocols. The GelFast from Medonyx dispenses an unscented gel that contains 70% ethyl alcohol and emollients to keep skin from drying out. You grasp and flip the container open, press down to squirt gel into your hand, flip it closed and rub the gel into your hands. The patent-pending nozzle dispenses the recommended amount of gel into your hand - 2cc of gel with one squirt - and lasts for between 25 and 30 washes per cartridge (a little more than two shifts), says Medonyx. The entire unit is recyclable. The company wouldn't give a price. For more information, call (866) MEDONYX, visit writeOutLink("www.medonyx.com",1) or circle number 169 on your Reader Service Card.
Keep instruments secure during sterilization
Healthmark's Laparoscopic ProTech Tray is designed to secure and protect delicate and expensive laparoscopic instruments of many dimensions during sterilization, storage and transportation. The two-level design of the Double Decker model (pictured) lets the tray hold twice the number of instruments in the same amount of space, says the company. And because they are made of anodized aluminum, the trays are lightweight and strong. Also available are extra Secur-Its and cushion mats for the base level of the tray. List price is $875. For more information, call (800) 521-6224, visit writeOutLink("www.hmark.com",1) or circle number 170 on your Reader Service Card.