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Surgical glove-associated diffuse lamellar keratitis
Richard S Hoffman1, I Howard Fine, Mark Packer
1Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, Oregon, USA. rshoffman@finemd.com
Purpose:
To demonstrate a potential cause of a prolonged epidemic of diffuse lamellar keratitis (DLK).
Method:
This retrospective review analyzed an epidemic of diffuse lamellar keratitis over a 3-year period in a single surgery center. Altering the brand of surgical gloves used during surgery was associated with an elimination of the DLK epidemic. Optical microscopy, scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS), and Fourier transform infrared (FTIR) spectroscopy were performed on both brands of surgical gloves to allow for comparisons and determine possible surface contaminants responsible for the DLK outbreaks.
Results:
The incidence of DLK during the epidemic ranged from 2% to 38% on a quarterly basis for the 3-year period. A change in the brand of surgical gloves resulted in a cessation of DLK. Surface analysis of both brands of gloves revealed extensive silicone oil contamination on the internal and external surfaces of the DLK-associated gloves and insignificant amounts of silicone oil on the external surface of the DLK-free gloves.
Conclusion:
Silicone oil contamination of surgical gloves appears to be associated with epidemic DLK.
Insights
Silicone oil contamination on surgical gloves was identified as a cause of diffuse lamellar keratitis (DLK) outbreaks. Changing glove brands eliminated the epidemic, highlighting glove contamination as a key factor in DLK.
Area of Science:
- Ophthalmology
- Materials Science
Background:
- Diffuse lamellar keratitis (DLK) is an inflammatory condition affecting the cornea.
- Prolonged DLK epidemics can significantly impact surgical center patient outcomes.
Purpose of the Study:
- To investigate the cause of a multi-year epidemic of diffuse lamellar keratitis (DLK).
- To identify potential contaminants on surgical gloves linked to DLK outbreaks.
Main Methods:
- Retrospective analysis of DLK incidence over three years.
- Comparison of surgical glove brands using optical microscopy, SEM-EDS, and FTIR spectroscopy.
- Correlation of glove brand with DLK epidemic occurrence.
Main Results:
- DLK incidence varied from 2% to 38% quarterly during the epidemic.
- Switching surgical glove brands led to the cessation of DLK cases.
- DLK-associated gloves showed extensive silicone oil contamination, unlike the control gloves.
Conclusions:
- Silicone oil contamination on surgical gloves is strongly associated with epidemic diffuse lamellar keratitis.
- Surgical glove selection and quality control are critical for preventing DLK outbreaks.
