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Sterile endophthalmitis after sutureless cataract surgery
D B Nelson1, E D Donnenfeld, H D Perry
1Department of Ophthalmology, Mercy Medical Center, Rockville Centre, New York.
Ophthalmology
|November 1, 1992
Summary
Refrigerated balanced salt solution (BSS) used during sutureless cataract surgery may increase the risk of sterile endophthalmitis. Discontinuing refrigerated BSS eliminated these complications, suggesting it should be avoided with periocular injections.
Area of Science:
- Ophthalmology
- Surgical Innovation
- Infectious Disease
Background:
- Sutureless cataract surgery offers rapid visual rehabilitation and reduced astigmatism.
- This technique relies on specialized lamellar incisions.
- Complications associated with new surgical methods often emerge over time.
Observation:
- Nine cases of sterile endophthalmitis were reported following sutureless cataract surgery.
- All cases occurred during a period using refrigerated balanced salt solution (BSS) for irrigation.
- These incidents involved two surgeons using similar techniques.
Findings:
- The use of refrigerated BSS in conjunction with subconjunctival injections of cefazolin and/or methylprednisolone was noted in all sterile endophthalmitis cases.
- Discontinuation of refrigerated BSS led to a complete cessation of sterile endophthalmitis episodes.
- No further cases occurred in the subsequent 650 surgeries after the change in irrigation solution.
Implications:
- Refrigerated BSS may impede wound sealing, potentially allowing subconjunctival injectates to enter the anterior chamber.
- Avoidance of refrigerated BSS is recommended when periocular injections are administered post-sutureless cataract surgery.
- Further research may clarify the mechanism by which cold BSS contributes to sterile endophthalmitis.