Simons Rob W P, Rondas Luigi U E, van den Biggelaar Frank J H M, Berendschot Tos T J M, Visser Nienke, de Crom Ronald M P C, Nuijts Rudy M M A
From the University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands (Simons, Rondas, van den Biggelaar, Berendschot, Visser, de Crom, Nuijts); Department of Ophthalmology, Zuyderland Medical Center Heerlen, Sittard-Geleen, the Netherlands (Visser, de Crom, Nuijts).
J Cataract Refract Surg. 2021 Aug 1;47(8):982-990. doi: 10.1097/j.jcrs.0000000000000577.
To investigate the economic impact of an intracameral mydriatics and anesthetic agent (ICMA), topical mydriatics, and a mydriatic ocular insert in cataract patients.
One public hospital in the Netherlands.
Prospective cohort study.
Resource use data were collected from a healthcare and societal perspective on the day of surgery. Other outcome parameters included pupil size, surgeon satisfaction, postoperative pain, and Catquest-9SF scores.
A total of 368 patients were included, the mean costs per patient were €506 in the ICMA group (n = 122), €474 in the ocular insert group (n = 115), and €451 in the topical group (n = 131). The acquisition cost of ICMA was highest and resulted in longer surgical time. After correction for an imbalance in the distribution of fast and slow surgeons, the mean costs in the ocular insert and topical groups were comparable (€450 vs €444). There was no statistically significant difference in the use of additional mydriatics intraoperatively (P = .521). The mean ratio of pupil size to white-to-white distance was lower in the ICMA group during all intraoperative measurements (P < .001) but similar between the topical and ocular insert groups (P range .11-.82).
In the investigated setting in the Netherlands, ICMA was the most costly strategy. In addition, pupil size was lowest in the ICMA group but did not result in more additional mydriasis measures intraoperatively. The ocular insert was comparable with topical mydriatics in costs and pupil size. Implementation of ICMA could be considered when availability of nurses or physical space for perioperative care is limited.
研究前房内散瞳剂与麻醉剂（ICMA）、局部散瞳剂和散瞳眼用植入物对白内障患者的经济影响。
荷兰的一家公立医院。
前瞻性队列研究。
从医疗保健和社会角度收集手术当天的资源使用数据。其他结果参数包括瞳孔大小、外科医生满意度、术后疼痛和Catquest-9SF评分。
共纳入368例患者，ICMA组（n = 122）每位患者的平均费用为506欧元，眼用植入物组（n = 115）为474欧元，局部用药组（n = 131）为451欧元。ICMA的购置成本最高，且导致手术时间更长。在纠正了快速和慢速手术医生分布不均衡的情况后，眼用植入物组和局部用药组的平均费用相当（450欧元对444欧元）。术中额外使用散瞳剂的情况无统计学显著差异（P = 0.521）。在所有术中测量中，ICMA组的瞳孔大小与角膜横径之比的平均值较低（P < 0.001），但局部用药组和眼用植入物组之间相似（P范围为0.11 - 0.82）。
在荷兰的研究环境中，ICMA是成本最高的策略。此外，ICMA组的瞳孔大小最小，但术中并未导致更多额外的散瞳措施。眼用植入物在成本和瞳孔大小方面与局部散瞳剂相当。当围手术期护理的护士可用性或物理空间有限时，可以考虑使用ICMA。
