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Biomedical subjects

Steve A Arshinoff

Publications and source records attributed to Steve A Arshinoff.

11 recordsLinked to original sources
PubMed2006

Simultaneous bilateral cataract surgery: Financial differences among nations and jurisdictions.

PURPOSE: To identify and measure financial pressures surrounding unilateral and simultaneous bilateral cataract surgery in Canada and other Western nations to understand financial factors that may affect simultaneous bilateral cataract surgery. SETTING: Eye Foundation of Canada, York Finch Eye Associates, Humber River Regional Hospital, University of Toronto, Toronto, Ontario, Canada. METHODS: Schedules of physician benefits from 4 Canadian provinces and public and private sectors in the United States were applied to a consistent template for unilateral and simultaneous bilateral cataract surgery. Well-known surgeons from the United Kingdom, Australia, Japan, and Israel provided additional information. The data were analyzed for similarities and differences to identify financial factors that may influence surgeons and anesthesiologists regarding simultaneous bilateral cataract surgery. RESULTS: Simultaneous bilateral cataract surgery yielded approximately 15% greater efficiency in the number of daily operations. Ophthalmologists' surgical fees were variably discounted for the second cataract surgery, up to 100% in some jurisdictions. Financial incentive issues were compounded by widely differing reimbursement schemes across regions. Anesthesiologists were generally reimbursed for simultaneous bilateral cataract surgery through additional time units of pay, not for additional surgical complexity. Simultaneous bilateral cataract surgery led to greater administrative, laboratory, and nursing efficiencies for institutions with minimal increases in overall complexity. CONCLUSIONS: Results show that discounting second-eye cataract surgery in simultaneous bilateral cataract surgery was a financial deterrent. Although increased efficiency was a slight incentive to ophthalmologists and surgical centers, anesthesiologists experienced significant financial disincentives.

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PubMed2005

New classification of ophthalmic viscosurgical devices--2005.

PURPOSE: To revise the generally accepted classification of ophthalmic viscosurgical devices (OVDs) to include cohesion data and the new class of viscous dispersive OVDs. SETTING: York Finch Eye Associates, Toronto, Ontario, Canada, and Alcon Research Limited, Fort Worth, Texas, USA. METHODS: Pseudoplasticity and cohesion-dispersion (CDI) data of DisCoVisc (hyaluronic acid 1.6%-chondroitin sulfate 4%), a new viscous dispersive OVD, were determined and compared with existing OVDs. The existing classification of OVDs was unable to accommodate its properties, so the classification was modified to include a new class and other potential new classes which currently remain unoccupied. RESULTS: Current OVD classification, although based on the clinically significant rheologic parameters of zero-shear viscosity and cohesion, only uses zero-shear viscosity because of the high correlation of these 2 parameters in existing OVDs. The appearance of DisCoVisc forces modification of the existing scheme because it does not fit into a preexisting category. The new proposed broadened classification is changed from a 1-dimensional list into a 2-dimensional table and considers CDI independently from viscosity for all OVDs. Expansion of the classification of OVDs in this manner predicts further possible new innovative OVDs for surgical use. CONCLUSION: The surgical behavior of OVDs can be predicted by their position in a classification of OVDs based upon zero-shear viscosity and cohesion.

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PubMed2004

Effect of retrobulbar injection of lidocaine on saccadic velocities.

PURPOSE: To determine whether exposing the extraocular muscles (EOMs) to lidocaine via retrobulbar injection for cataract surgery has a demonstrable negative effect on subsequent function of the muscle. SETTING: York Finch Eye Associates, Humber River Regional Hospital, and Toronto Western Hospital Research Institute, Toronto, Ontario, Canada. METHODS: This study comprised 37 eyes that had phacoemulsification and posterior chamber intraocular lens implantation; 13 eyes had retrobulbar lidocaine with hyaluronidase and 24 eyes, topical anesthesia. The postoperative saccadic velocities were compared with the preoperative velocities using a sensitive recording device. The results were compared within and between the retrobulbar lidocaine and topical anesthesia groups. RESULTS: No detectable decrement in postoperative saccadic velocities was detected in any patient, and no difference was found between the groups. CONCLUSIONS: Exposing EOMs to lidocaine for cataract surgery had no detectable negative effect on saccadic velocities 1 week after surgery.

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PubMed2003

Understanding, retaining, and removing dispersive and pseudodispersive ophthalmic viscosurgical devices.

PURPOSE: To analyze and explain the rheologic behavior of pseudodispersive viscoadaptive ophthalmic viscosurgical devices (OVDs) and compare it with that of dispersive OVDs. SETTING: York Finch Eye Associates and Humber River Regional Hospital, Toronto, Ontario, Canada. METHODS: Poiseuille's law was used as a basis of understanding fluid aspiration. Each OVD class was analyzed to determine how well it fit the law and why. RESULTS: Higher viscosity cohesive OVDs are removed in a manner predicted by Poiseuille's law. Lower viscosity dispersive and viscoadaptive OVDs are not. CONCLUSIONS: Lower viscosity dispersive OVDs possess inadequate cohesion to maintain continuous contact with the aspiration port during irrigation/aspiration, whereas viscoadaptive OVDs are too rigid to permit scrolling around obstacles in the eye (the intraocular lens), also resulting in interrupted contact with the aspiration port. Dispersion and pseudodispersion represent opposite ends of a spectrum of increasing cohesion and rigidity correlating with increasing zero-shear viscosity and are not similar.

Anterior Chamber↗
PubMed2003

Simultaneous bilateral cataract surgery.

PURPOSE: To evaluate the safety and outcomes of simultaneous bilateral cataract surgery (SBCS). SETTING: York Finch Eye Associates and Humber River Regional Hospital, Toronto, Ontario, Canada. METHODS: This retrospective study reviewed the results of 1020 consecutive patients (2040 eyes) who had SBCS by endolenticular phacoemulsification through a clear corneal incision on the corneal steep axis with foldable posterior chamber intraocular lens implantation. The surgeries were performed by the same surgeon from January 1996 to January 2002 as 2 consecutive independent procedures under topical and intracameral anesthesia. Outcome measures included intraoperative and postoperative complications, postoperative uncorrected and best spectacle-corrected visual acuities, refractive error, and patient satisfaction. RESULTS: Complications were few and would not likely have been prevented had the surgery been performed monocularly. CONCLUSIONS: Simultaneous bilateral cataract surgery did not lead to an increased incidence of intraoperative or postoperative complications. The visual acuity results were good, and the patients were pleased. No complications were observed that could be attributed to the procedures being done bilaterally.

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PubMed2002

Using BSS with viscoadaptives in the ultimate soft-shell technique.

The ultimate soft-shell technique compartmentalizes the anterior chamber using the ultimate low-viscosity fluid--water (as balanced salt solution [BSS] or trypan blue [Vision Blue])--in combination with 1 of 2 commercially available viscoadaptive ophthalmic viscosurgical devices: Healon5 (sodium hyaluronate 2.3%) or I-Visc Phaco (sodium hyaluronate 2.5%). The use of this technique facilitates cataract surgery with viscoadaptive OVDs and viscoadaptive removal at the end of the procedure.

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PubMed2002

Intraocular pressure after bilateral cataract surgery using Healon, Healon5, and Healon GV.

PURPOSE: To determine whether there is a difference in frequency or severity of postoperative intraocular pressure (IOP) spikes after bilateral phacoemulsification with complete ophthalmic viscosurgical device (OVD) removal when Healon5 (sodium hyaluronate 2.3%), Healon (sodium hyaluronate 1%), or Healon GV (sodium hyaluronate 1.4%) is used. SETTING: York Finch Eye Associates and Humber River Regional Hospital, Toronto, Ontario, Canada. METHODS: Bilateral cataract surgery was performed in 99 patients; 50 were randomly assigned to receive Healon5 in 1 eye and Healon GV in the fellow eye and 49, Healon in 1 eye and Healon GV in the fellow eye. The IOP was measured preoperatively as well as 5 and 24 hours and 7 days postoperatively. The mean IOP and standard deviation at each time interval were calculated for each OVD. The results were compared among the OVDs using Student t tests for each time at which IOP was assessed. RESULTS: There were no significant differences in postoperative IOP spikes among the Healon5, Healon, and Healon GV groups; however, patients receiving lower viscosity OVDs had a lower mean IOP at 24 hours. All groups had increased IOP at 5 and 24 hours and reduced IOP at 7 days. CONCLUSIONS: Within a family of molecularly similar OVDs, lower viscosity OVDs appear to cause slightly lower mean elevations in IOP in normal patients at 24 hours. However, if the OVD is removed, postoperative IOP spikes above 21 mm Hg appear related more to patient factors (eg, predisposition in glaucoma patients) and surgically induced trauma than to the specific long-chain non-cross-linked hyaluronan OVD used.

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