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Carpal tunnel syndrome

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By Dr. Edward R. Blocker

Carpal tunnel syndrome is a common malady that most people have heard of. However, I find that many patients will call any hand discomfort carpal tunnel syndrome. Symptoms of this condition are classically numbness and tingling of certain parts of the hand and fingers. Aching, sore knuckles are something else — most likely arthritis.

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Dr. Edward R. Blocker

Carpal tunnel syndrome is caused by irritation of a specific nerve in our wrist called the median nerve. When this nerve is irritated, the symptoms that patients experience are usually described as numbness, tingling, or burning of the hand and fingers. Most of us will experience these symptoms at some time or another. If it occurs only occasionally and is temporary, it is usually nothing to worry about just as when your foot occasionally “goes to sleep” and resolves when you reposition it.

Because this is a problem with a specific nerve, the pattern of numbness and tingling will be very specific. Nerves are like electrical wires in your house. Your house wiring passes through a breaker panel. If you flip the breaker to your living room, only the living room lights go out. Similarly, our nerves provide sensation to specific parts of our body. In the case of our hand, the nerve that causes carpal tunnel syndrome (called the median nerve) provides sensation to our thumb, index, long, and half of our ring finger. This median nerve comes down our forearm and goes through a passage in our wrist before branching out into smaller nerves that go out to our thumb and these 3 ½ fingers.

This wrist “passage” is the carpal tunnel. Much like the breaker switch, when the nerve gets compressed as it passes through the carpal tunnel, it will lead to numbness and tingling in these specific digits. While there are three main nerves that provide sensation to specific parts of our hand and fingers, only the median nerve passes through the carpal tunnel. It’s how we are wired.

When a patient comes in with these complaints, they will often say their “whole hand goes to sleep.” However, if you really pay attention to what part of your hand and digits go numb while it’s happening, a pattern will usually emerge.

Symptoms can occur day or night. Classically, daytime symptoms occur with almost any hand intensive activity: driving, writing, typing, reading a book, etc. Many are quick to blame their job but this is often simply a condition of life. It also frequently occurs at night, sometimes waking you from sleep. This usually occurs because your arms are bent under your pillow and wrist flexed. This can put a “kink” on the median nerve as it passes through the carpal tunnel. Straightening out your wrist will alleviate the symptoms. This is why sleeping in a wrist splint that holds your wrist in slight extension can help you sleep through the night.

Diagnosing carpal tunnel syndrome is usually straightforward. As you now know, asking which fingers go numb is usually telling. A simple exam of the hand during the office visit can then be confirmatory. There is an objective test called a nerve conduction study that can be performed as well. In general, most of us diagnose this condition through questioning and physical exam, and will only obtain the nerve test in those cases that do not resolve with simple treatment and require surgery.

As far as treatment options, if it bothers you mostly with typing, modification of your workstation can help. Another simple option is the splint I just mentioned. The splint rests the nerve from repetitive flexing and holds the wrist in a position that allows maximal volume in the carpal tunnel. Any drugstore carries them. I usually start by having the patient wear it at least at night. Other options include anti-inflammatories (if your doctor says you can take them), cortisone injection of the carpal tunnel, and surgery. Anti-inflammatories and injections can work by quieting down inflammation of the nerve and/or the area around the nerve.

Carpal tunnel surgery involves releasing a ligament that forms part of the wall of the carpal tunnel thereby relieving compression on the nerve. It is usually a quick procedure that can be done in under 10 minutes. Although it is a quick procedure, I stress to patients that there is a more lengthy recuperation time. Also, nerves are unpredictable as to when they decide to “wake up” after surgery. Sometimes patients feel better in the recovery room, sometimes it takes several days, sometimes weeks.

Fortunately, not every case of carpal tunnel syndrome requires surgery. Treatment is often decided based on the degree that the symptoms bother you and can usually start with simple options.

Edward R. Blocker, MD, is a board-certified orthopaedic surgeon with Beaufort Memorial Orthopaedic Specialists. A graduate of the Medical University of South Carolina, Dr. Blocker completed his internship and residency at the Greenville Hospital System University Medical Center and the Shriners Hospital for Crippled Children – Greenville Unit. He has been practicing in Beaufort for the past 18 years.

Paralyzed man to run in Port Royal Super Heroes 5K

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A highlight of the Super Heroes 5K run in Port Royal, on April 23rd will be the appearance of Adam Gorlitsky who has overcome paralysis from the waist down to compete in running competition. He was one of the first paralyzed persons in history to compete in the Cooper River Run on April 2nd.

The 29-year-old Gorlitsky will compete in the race using a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk. He was paralyzed in a car crash at 19 years of age. The exoskeleton system provides user-initiated mobility through the integration of a wearable brace support, a computer-based control system and motion sensors. The system allows independent, controlled walking while mimicking the natural gait patterns of the legs. ReWalk, developer of the system, is the only FDA cleared exoskeleton system in the U.S., with clearances for both personal use at home and in the community, as well as for the rehabilitation setting.

Proceeds from the 5K run will go to the Port Royal Elementary School 4th and 5th Grade Girls Run Club, which educates young female runners on the benefits of running. A portion of the proceeds also will go to the Child Abuse Prevention Association of Beaufort County (CAPA).

The April 23 race starts at 8 a.m., beginning and ending at Live Oaks Park, corner of 14th Street and London Avenue, according to McDuff. Pre-registration is available online until April 20 and also from 7 to 7:30 a.m. on race day. T-shirts are guaranteed to participants who register by April 15. Registration and packet pickup is from 4 to 6 p.m. April 22 at Port Royal Elementary School and on race day at Live Oaks Park, Port Royal from 7 to 7:30 a.m. Early discounted registration price is $20 adults and $15 for students. Registration is through www.active.com; superhero5kpres.com or on Facebook at  PresSuperHero5K.

“This is a dog friendly race,” McDuff said, “and race volunteers would be welcomed.”

Ease your mind with meditation: here’s how

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By Brittney Hiller

What is meditation? Meditation has shown to reduce stress and anxiety, lower blood pressure, and create ease in the practitioners’ life. Meditation is simply, a moment for you to create space in your life that will encourage and enhance awareness as well as creativity.

{Doesn’t that sound YUMMY?}

As a yoga teacher, I practice meditation in many different forms, from transcendental (which has been deeply studied by Dr. Herbert Benson and taught to students at Harvard University), to visualization meditation. Recently, I have had the pleasure of speaking with many students whom have wanted more meditation in their life.

Here is ONE quick way to jumpstart your meditation practice, TODAY – like, right now. {yup, now, now}

For two minutes (you have two minutes), turn off Facebook and Instagram or the TV and voila’ you have created two minutes. Now, comfortably sit upright, perhaps in a chair or on a pillow on the ground. If you find yourself at a desk, perfect! Face your computer and begin with this easy step.

Place your index finger to your thumb. Now we are going to rotate out our fingers with our thumb, therefore the rotation looks like so,

Thumb to Index finger

Thumb to Middle finger

Thumb to Ring finger

Thumb to Pinky.

You got it!

Now with this rotation we are beginning to empower the brain to think actively, which is GREAT for creativity! The fun begins here, where you can create a mantra, a repetitive and uplifting phrase such as
PEACE BEGINS WITH ME.

See how we have four places with our finger to put in four words, and then repeat? Awesome!

Create a mantra that suits you best.

TODAY I WILL RELAX

I AM HAPPY TODAY

PEACE BEGINS WITH ME

I AM AT EASE

MY DAY IS GREAT

{You’ve got it now}

With each rotation of your fingers, you place a word.

Breathe slowly and deeply with each round and give yourself 2 minutes to do this. As I often encourage, truly notice HOW you feel before and then after. It is a small gift for you today, but I hope you take the moment and ‘Treat yo’ Self!’

Kailos Genetics and Bluffton’s “Teal It’s Gone” to provide affordable hereditary cancer testing

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Kailos Genetics, a personalized medicine company offering leading-edge gene-based genetic testing, announced recently that they have entered into a partnership with Teal It’s Gone, a nonprofit organization focused on impacting ovarian and peritoneal cancer through genetic testing to provide reduced cost hereditary cancer screening.

“We want all people to have access to their health information so they can make more informed decisions. We view partnerships like this as an integral part of achieving that goal. As someone who has personally been impacted by genetic testing to identify hereditary cancer, I am especially excited to partner with Kailos Genetics to provide people with affordable genetic testing,” said Katie Maxell, founder, Teal It’s Gone. “Our complementary missions to improve patient health knowledge to positively impact outcomes will enable us to make a bigger impact in people’s lives.”

This agreement enables Kailos and Teal It’s Gone to increase awareness of genetic testing as a tool for early cancer detection and improved treatment options by giving patients access to the Kailos hereditary cancer screening test for as low as $125. This is substantially reduced from standard hereditary cancer screening tests which are offered for upwards of $500.

According to the National Cancer Institute, genetic mutations are thought to play a role in about 5 to 10 percent of all cancers. Identifying these risks early can lead to better outcomes through earlier and more informed treatment plans.

Vitamin see: foods rich in vitamin C may help slow cataracts

in Contributors/Dr. Mark Siegel, MD FAAO/Health by

By Dr. Mark S. Siegel

What do grapefruit, broccoli and strawberries have in common?

They are foods loaded with vitamin C, which could help slow cataract progression, according to a British study.

Cataracts are a clouding of the eye’s lens that happens naturally with age. The condition is the leading cause of blindness in the world, according to the World Health Organization.

Researchers from King’s College London examined data from more than 1,000 pairs of female twins to see what factors may help keep cataracts at bay. They tracked intake of vitamin C and other nutrients from food and supplements. They also recorded how opaque the subjects’ lenses were at around age 60, with a follow-up on 324 sets of twins about 10 years later.

Women who reported consuming more vitamin C-rich foods had a 33 percent risk reduction of cataract progression over the decade, according to the study. Their lenses overall were more clear.

Although we cannot totally avoid developing cataracts, we may be able to delay their onset and keep them from worsening significantly by eating a diet rich in vitamin C. The researchers noted that the findings only pertain to vitamins consumed through food and not supplements.

Vitamin C is a powerful antioxidant. The fluid inside the eyeball is normally high in a compound similar to vitamin C, which helps prevent oxidation that results in a clouded lens. Scientists believe more vitamin C in the diet may increase the amount present around the lens, providing extra protection.

Because the study was done in twins, the team was also able to calculate how much of a role genetics versus environmental factors play in cataract progression. While environmental factors, such as diet, accounted for 65 percent, genetic factors only accounted for 35, indicating that diet and lifestyle may outweigh genetics.

The study, “Genetic and Dietary Factors Influencing the Progression of Nuclear Cataract“ will be published this June in Ophthalmology, the official journal of the American Academy of Ophthalmology.

What we hear when we need to hear it

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By Martha O’Regan

Even when you don’t realize you are searching for answers to life’s tough questions, sometimes answers appear in strange yet magical ways and wake you up. I have come to believe we all have an opportunity to ‘awaken’ to our purpose on the planet, yet too often life is so busy and noisy that we either miss the signs or misinterpret the messages.

Back in the day, not too very long ago, when I believed that I was ‘in charge’ of my life and that if I wanted something done, I had to do it myself, I put expectations on someone who didn’t come through for me on ‘my’ time, ultimately slowing down ‘my’ progress. My immediate reaction was anger along with a few words about incompetency and ‘ruining everything’ I was working towards! It was on a Friday and there was nothing I could do to ‘fix’ it, so I went home to take out my frustrations by playing in the dirt and pulling a few weeds. After calming down, I went inside to check my business voicemail, a message had come in about the time of my ‘upset’ that ultimately woke me up and continues to direct my life today.

A very robust female voice repeated ‘Clean House, Help Others, Trust God’ three times then hung up. The first was as a statement, the 2nd with a ‘duh, don’t you get it’ tone to it, and the 3rd was with the most joyful laughter I could ever imagine at the time. There was no caller ID or info from *69. I listened to it several times but because I was living in my ‘’I make things happen’ mentality, I wrote it off as an advertisement of some sort. As I shared the story with friends, I was surprised that no one else had received the same message. As days went on, I began to contemplate the meaning of this strange communication, settling on the literal interpretation because at the time, we were trying to get our home on the market, I was beginning a professional organizing business as an adjunct to my muscle therapy business, and seldom going to church…it made sense, I guess.

Fourteen years later, I continue to apply my ‘phone call from God’ to every aspect of my life including physical, spiritual, financial, political, environmental, emotional, and bio-chemical, continuing to find ways to simplify all areas (clean house), discovering ways to be in service (help others), trusting that there is a Divine plan unfolding (trust God), and realizing that I am not in charge after all….who knew?

Despite the great comfort and sometimes frustration in its simplicity, I have come to believe this message was not intended just for me but to be shared for others’ consideration. This timeless statement can be interpreted literally and/or figuratively depending on your personal circumstances as you move towards slowing down, taking care of your mind and body, while discovering your higher purpose in life. I continue to hear it from many perspectives depending on what I am seeking to learn in the moment.

As a culture, it is apparent we are going through a time of ‘cleaning house’, some due to external circumstances beyond our control and some by conscious choice, either way, we’re discovering that it feels better to release the attachments and all the associated ‘gunk’ than the pressure of trying to ‘hold on’ to it. It also appears we are becoming more compassionate, seeking ways to support efforts to be of service to those under-served in our community and beyond, not just through money but ‘hands on’ labor of love. And, regardless of specific affiliations with a church community, there is a sense that more folks are seeking comfort in a ‘Higher Power’ to show them the way through both good and difficult times, uniting us more deeply.

So, it is with great joy that I share my ‘phone call from God’ with hope that it serves a purpose for someone else. Live Awake….Have Fun!

Park Plaza Cinema presents The Untold Story of Lyme

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On April 5th, Park Plaza Cinema presents “Under Our Skin”, The Untold Story of Lyme Disease, in honor of the Park Plaza Cinema’s Operations Director, Vanessa Leite who is battling Stage 3 Lyme Disease.  Vanessa, a resident of Bluffton, was diagnosed in October 2015 after six grueling years of medical mystery and visits to over 30 specialists. Since starting with the cinema, Vanessa has met many people who are either suffering from Lyme Disease, had Lyme disease or have a loved one or friend impacted by this debilitating disease.

“People are truly unaware of the seriousness of Lyme Disease and we are seeing that now as we have grown closer to Vanessa. In light of that, Larry and I would like to bring awareness to the Lowcountry by showing the documentary and bringing expert speakers to share their knowledge about this disease,” said Lucie Mann, Owner of Park Plaza Cinema.

The event will begin with a reception at 6:00 p.m. including food and wine provided by Whole Foods of Hilton Head and Burnin’ Down South in Okatie, along with many other health and wellness sponsors.  The documentary will begin at 7:00 p.m. followed by Q&A with experts in the field and several Lyme Disease warriors. The event is $10 per ticket and open to the public.

One difficulty in diagnosing Lyme disease is the fact that its symptoms are very broad. They seem to mimic those of other diseases and they vary from patient to patient. This documentary investigates the epidemic we are now facing and traces its flourishing to a negligent and corrupt health care system. Interviews with patients and doctors paints a clear picture of a medical industry that has decided to place profits ahead of the health of the people it is supposed to be treating.

As space is limited, attendees are encouraged to purchase tickets in advance at the Park Plaza Cinema box office or online at www.mannparkplazacinema.com. Tickets are on sale now.

Younger looking skin…the rest of the story

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By Dr. Robert Knitzer

No matter what our age, we all want to look our best. Many of us are also thinking about ways to turn back the hands of Father Time.

The Skincare/Beauty Industry has a multitude of products all claiming to promote “younger looking skin.” From soothing to superficial, there is a huge spectrum of offerings. But how many of these products actually help the body to be healthier?

Recently the National Institute for Occupational Safety and Health analyzed 2,983 chemicals used in personal care products. What they found was astonishing. Eight hundred and eighty-four of the chemicals were toxic; 314 caused biological mutations; 218 caused reproductive complications; 148 caused tumors and 376 caused skin and eye irritations. This is unacceptable in this day and age. Industry can do better.

In my previous article of January 21, I discussed a safe, non-toxic, breakthrough health technology which promotes accelerated cellular healing based upon the cutting edge science of Redox Biochemistry. In this article, I want to share some of the recently completed science studies in this new field and what this means for us in our never ending quest to look younger.

To truly look younger you need to be younger at the cellular level. Cells are the building blocks of all tissues, organ systems, in fact, the entire body. Here Redox Biochemistry, through the creation of tiny signaling molecules gives our bodies messages of what needs to be done to rejuvenate healthy cells and either repair or replace damaged cells.

Unfortunately, over time, due to stress and the barrage of environmental toxins in our lives, our immune function declines and normal skin cell function is diminished. We lose the balance of redox signaling molecules required for optimal health.

One company has developed a skin renewal product based on this technology. It has undergone independent testing by global leaders in dermatologic research. Dermatest Lab in Germany has done several studies on this product. Their initial studies on women using this product alone for 28 days showed an improvement in six key areas of skin health: decreased eye wrinkle depth and overall wrinkle depth of greater than 20%; increases in facial skin texture, skin smoothness, skin elasticity of greater than 20% and an increase in skin moisture of 11%.

A more recent clinical study on cellulite noted a 20% increase in skin elasticity and an improvement in the appearance of cellulite. Based upon these findings and its safety, the product was given Dermatest’s coveted 5-star clinically tested seal of excellence.

Stephens & Associates in Dallas, Texas performed studies on the topical gel applied to one forearm. It found skin cell renewal and turnover was increased by 16% in that arm as compared to the arm without the redox signaling gel. They also studied whether there was increased blood flow in the skin as an explanation of enhanced skin healing. Those results indicated a 49% immediate increase after first application which increased to 55% by day 4.

Combined, these studies indicate that the application of the redox signaling gel enhanced replacement of damaged skin cells with healthy cells and increased blood flow and oxygenation to the treated area.

This is a safe, revolutionary and foundational approach to how we think about and improve skin health. “And Now You Know The Rest Of The Story.”

The secret power that lives inside of us

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By Brittney Hiller

Sleep walking through life, like a Zombie straight out of “The Walking Dead”, you know them you’ve seen them, the people who go about their business everyday doing the same thing and not thinking twice about it. That was me at twenty-five, until I was smacked in the face by reality.

You see, my ‘sleep walking’ was unhealthy, it looked more like a college freshman who was raised by a pastor and had never seen the light of day, but yet was free for the first time. It was early morning work hours to late night wine and cheese parties that often ended with a jug of wine emptied. This was my ‘real life’.

My turning point was when an incident occurred to me that literally caused me to have to WAKE UP, wake up from the sleep walking, wake up from the ‘routine’ that I created, wake up to the truth that my life was unhealthy.

After this incident I completely detached from my body mentally because I wanted to pretend that I didn’t actually have a pregnancy caused by a date gone wrong. Seven months in I was hit with my ah-ha moment, something is going to happen whether I liked it or not. I quickly turned to my sister for help and I knew adoption was my answer. I am forever grateful to my sister as she helped to catapult me into a cycle of coming clean.

Not a single person knew of my plight for seven months, not even my fresh, new, brightly lit smiling, boyfriend. He would ask often and I neglected to tell him the truth each time, coyly referring to my growing belly as a beer gut.

I wanted to continue to see him, but I didn’t want him to feel sorry for me and feel he ‘had’ to stay with me because I was ‘the pregnant girl’, regardless of my reason for not being honest, in my mind and body I felt, “I am not pregnant, this will pass.” However, he knew, he knew from the beginning and yet, I continued to lie, until I simply could not lie anymore.

Fast forward to the moment I came clean and let my belly fly free, no longer holding it in or pretending. My mother became concerned and I finally let the tears flow and the truth to soar. A whirlwind of positive experiences occurred after I told my story. Friends, family, and strangers even began to assist in the ease of this transition. What about my bright, smiling boyfriend? He was next to my side, holding my hand during my chosen caesarean delivery, as to ease the adoption process. To this day he holds my hand, shows me what actual strength and true courage is, and helps guide my big dreams. I am truly honored to be his wife.

Through this life event I could have been bogged down with turmoil and emotion, beating myself up and believing I was undeserving of love, yet instead I saw the power in gifting a child, unassuming to my situation, to a loving family.

I began to lead life with an open heart. It was as if I awoke from a dream, I awoke from my robotic way of life. I was finally able to see me, with a little help from my friends.

I began to share my secret power, my story. With those that I shared with they began to share their story, too. Stories all around were being shared because I opened up the floor; lives were being shifted because they saw another option to what ever they may have been troubled by. You see, whatever your story, whatever your pain, you can be the light for others through your sharing. When we hold our stories in, it creates heaviness, when we let it out we become lighter in all ways and we shine.

Dropless Cataract Surgery: What are the potential risks?

in Contributors/Dr. Mark Siegel, MD FAAO/Health by

By Dr. Mark S. Siegel

Cataract surgery continues to evolve, with microincisional clear corneal incisions, femtosecond lasers, new imaging modalities, and improved lens implants. However, the published literature is having trouble keeping up with clinical practice. Despite the ongoing change, one concern remains constant: endophthalmitis (infection) prophylaxis. The use of perioperative povidone-iodine, a lid speculum, and drape with isolation of lids and lashes, and sterile preparation, is effective in limiting the incidence of endophthalmitis after cataract surgery.

The recent advent of “dropless” cataract surgery via transzonular ocular injections of TriMoxi or TriMoxiVanc, offers another option of infection prophylaxis. As some cataract surgeons consider adopting dropless cataract surgery it is important to balance the potential complications and risks involved with this technique.

These combinations of antibiotics and steroids are delivered to the anterior vitreous (jelly that fills the back of the eye) by injection through the zonules (tiny spider web-like ligaments that anchor the lens to the wall of the eye). This is intended to mitigate the need for post-operative topical drops. Drops can be costly, can irritate the surface of the eye, can be difficult for some patients to administer and can be burdensome to prescribers. Though post-operative drops are less than ideal, this new mode of dropless infection prophylaxis contains some inherent risks.

A clear concern is compounding errors. There have been reports of dilutional errors with intraocular antibiotics that have resulted in complications including macular swelling, retinal detachment, macular infarction, toxic anterior segment syndrome (severe inflammation) and a large outbreak of Fusarium endophthalmitis.

The pharmacokinetics of TriMoxi(+/-) Vanc is unclear when placed in the anterior vitreous. These antibiotics have the shortest half-life of current intravitreal antibiotics being used (1.7 hours). Vancomycin has a half-life of 25.1 hours. Routine topical antibiotics are able to produce concentrations inside the eye for a week post-operatively. While one European study showed decreased rates of endophthalmitis with injected antibiotics, all arms of the study used 6 days of topical postoperative antibiotics! The question remains: is the duration of coverage with injected antibiotics without topical antibiotics adequate?

Antibiotic resistance is another consideration when using TriMoxi. Emerging resistance has been identified. A recent review found resistance rates to moxifloxacin has increased from 21% in 1995 to 62% in 2014.

The use of prophylactic vancomycin in TriMoxiVanc during routine cataract surgery is controversial. The Centers for Disease Control issued guidelines in 1995 specifically discouraging the use of vancomycin in routine surgical prophylaxis because of increasing bacterial resistance. The risk of fueling the emerging resistance to vancomycin for an unproven practice is worrisome. Given that there are more than 3 million cataract surgeries performed in the United States each year, exposure of the ocular surface to low doses of vancomycin could result in an increase in vancomycin resistant bacteria.

Another unknown is the risk of steroid-induced ocular hypertension (elevated eye pressure) associated with TriMoxi(+/-) Vanc. It is well known that topical steroids can induce ocular hypertension, but drops are easily discontinued, whereas injected intraocular steroids are not. Currently there is a paucity of literature addressing transzonular triamcinolone (the steroid component in TriMoxi) and its associated ocular hypertension risk. Furthermore, the use of triamcinolone leaves patients with obscured vision and floaters for the first week or more. Patient complaints of foggy vision postoperatively have led some cataract surgeons to discontinue the product. Many randomized trials show that topical nonsteroidal anti-inflammatory drugs (NSAIDS) are superior to topical steroids in reducing post-operative macular swelling after cataract surgery. Thus, regardless of the intraocular steroid and antibiotic used, it is likely that a topical NSAID will need to be prescribed.

Technical and mechanical issues must be considered in addition to issues of bacterial resistance, compounding risks, steroid-induced elevated eye pressure, and post-operative foggy vision. In patients with lens zonular weakness (pseudoexfoliation), intraocular lens (IOL) decentration or dislocation may occur. The impact of this technique for premium IOL decentration could create significant visual disturbance. Since most patients using blood thinners do not discontinue this medication, there could be intraocular hemorrhage from inadvertent cannula contact with the iris ciliary muscle. Finally, very short eyes may not have the space to accommodate the injected volume of these antibiotic and steroid preparations.

Today’s cataract surgery is safer for the patient and shorter in duration than in decades past. Improvements in technology, techniques, and training have led to improved outcomes for our patients. Although the concept of dropless cataract surgery is clearly attractive, cataract surgeons should consider the serious issue of bacterial resistance and the unnecessary risk of the transzonular delivery of TriMoxi(+/-) Vanc. In an era of increasing cost-benefit analysis where physicians will be judged on outcomes and the allocation of limited healthcare resources, the value of dropless cataract surgery remains uncertain, risky and currently not the standard of care.

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