Sterile hypopyon secondary to ultrasonic cleaning solution

Area of Science:

• Ophthalmology
• Surgical Infections
• Sterilization Science

Background:

• A series of sterile hypopyon cases occurred post-cataract surgery.
• The cause was initially unknown despite thorough investigation of surgical protocols.

Purpose of the Study:

• To identify the source of sterile hypopyon following uncomplicated cataract surgery.
• To determine the link between ultrasonic cleaning solutions and postoperative inflammation.

Main Methods:

• Clinical observation of 21 sterile hypopyon cases post-cataract extraction.
• Investigation of surgical instruments and sterilization techniques.
• Laboratory analysis of instrument contamination using heat-stable endotoxin identification.

Main Results:

• A correlation was found between sterile hypopyon and the use of older ultrasonic cleaning solutions for surgical instruments.
• Instruments were contaminated with a heat-stable endotoxin that persisted through autoclaving.
• Contaminated instruments led to severe postoperative inflammatory reactions.

Conclusions:

• Older ultrasonic cleaning solutions can harbor heat-stable endotoxins.
• Endotoxin contamination on surgical instruments, even after autoclaving, can cause sterile hypopyon.
• Surgeons using ultrasonic cleaners must be aware of potential endotoxin contamination risks.